MEDICARE: XSPURT PROVIDER SERVICES, INC.

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1952980062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	XSPURT PROVIDER SERVICES, INC.

Provider Business Mailing Address
First Line	:	6283 NW 201ST TER STE 2A
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2194
Country	:	US
Telephone Number	:	786-863-4915
Fax Number	:	305-624-7285

Provider Business Practice Location Address
First Line	:	6283 NW 201ST TER STE 2A
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2194
Country	:	US
Telephone Number	:	786-223-0386
Fax Number	:	305-624-7285

Authorized Official
Title or Position	:	PRESIDENT AND DIRECTOR
Name	:	DR. LINDA JOYCE WASHINGTON-BROWN
Credential	:	APRN
Telephone Number	:	786-223-0386

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	04/06/2021

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