MEDICARE: LICE POLICE 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	247200000X	Other Technician

General Provider Information

NPI Number	:	1235670191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LICE POLICE INC

Provider Business Mailing Address
First Line	:	520 S MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-2977
Country	:	US
Telephone Number	:	217-204-9227
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 S MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-2977
Country	:	US
Telephone Number	:	217-204-9227
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MRS. OLIVIA MAE MEFFORD
Credential	:
Telephone Number	:	217-370-4635

Provider Enumeration Date	:	03/12/2017
Last Update Date	:	03/12/2017

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Directions to “LICE POLICE INC ” Practice Location

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