MEDICARE: MDPA SOLUTIONS, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2084N0400X	Neurology Physician
2	225100000X	Physical Therapist
3	363A00000X	Physician Assistant
4	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1992181077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDPA SOLUTIONS, INC

Provider Business Mailing Address
First Line	:	502 PALMETTO ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7325
Country	:	US
Telephone Number	:	386-957-1854
Fax Number	:	386-878-4967

Provider Business Practice Location Address
First Line	:	502 PALMETTO ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168
Country	:	US
Telephone Number	:	386-957-3810
Fax Number	:	386-878-4967

Authorized Official
Title or Position	:	PHYSICIAN ASSISTANT
Name	:	MR. ELLIS FRANKLIN FORT III
Credential	:	P.A.
Telephone Number	:	386-957-1854

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	01/23/2026

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