MEDICARE: AMERICAN DIAGNOSTIC CARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician

General Provider Information

NPI Number	:	1952548273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN DIAGNOSTIC CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1914 FRANKFORD AVE
Second Line	:	APT 201
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-3006
Country	:	US
Telephone Number	:	407-902-9296
Fax Number	:

Provider Business Practice Location Address
First Line	:	11111 PANAMA CITY BEACH PKWY
Second Line	:	SUITE 10
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2448
Country	:	US
Telephone Number	:	407-902-9296
Fax Number	:

Authorized Official
Title or Position	:	PART OWNER
Name	:	MOHAMED HEGAZY
Credential	:
Telephone Number	:	407-902-9296

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	01/08/2009

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