MEDICARE: VANALLEN & ASSOCIATES, 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	251B00000X	Case Management Agency	ND1732	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	683658596	OTHER	FL	STATE OF FLORIDA MEDWAVIER PROVIDER NUMBER

General Provider Information

NPI Number	:	1982040648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANALLEN & ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	1102 N WILLOW AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5552
Country	:	US
Telephone Number	:	813-258-6231
Fax Number	:	813-258-6232

Provider Business Practice Location Address
First Line	:	1102 N WILLOW AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5552
Country	:	US
Telephone Number	:	813-258-6231
Fax Number	:	813-258-6232

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. LINDA VANALLEN EVANS
Credential	:	RD, LD
Telephone Number	:	813-258-6231

Provider Enumeration Date	:	05/21/2013
Last Update Date	:	05/21/2013

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