MEDICARE: ENDURACARE ACUTE 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1982118188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDURACARE ACUTE CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	381 RIVERSIDE DR STE 440
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-8934
Country	:	US
Telephone Number	:	615-861-8755
Fax Number	:	615-472-1936

Provider Business Practice Location Address
First Line	:	513 W MARION AVE
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059-2748
Country	:	US
Telephone Number	:	601-281-5930
Fax Number	:	601-281-5964

Authorized Official
Title or Position	:	VP OF HUMAN RESOURCES
Name	:	JENNIFER BERRELL
Credential	:
Telephone Number	:	615-861-8755

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	11/27/2017

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