MEDICARE: PATRICK PENDLETON

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	343900000X	Non-emergency Medical Transport (VAN)
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1184239212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK PENDLETON

Provider Business Mailing Address
First Line	:	5786 SANDALWOOD BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3421
Country	:	US
Telephone Number	:	614-430-3137
Fax Number	:

Provider Business Practice Location Address
First Line	:	5786 SANDALWOOD BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3421
Country	:	US
Telephone Number	:	614-430-3137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2020
Last Update Date	:	09/15/2020

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Directions to “ PATRICK PENDLETON ” Practice Location

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