MEDICARE: JOHN A MCLENDON

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	172A00000X	Driver	2573301	OH
2	251X00000X	Supports Brokerage Agency	2573301	OH
3	343900000X	Non-emergency Medical Transport (VAN)	2573301	OH
4	347C00000X	Private Vehicle	2573301	OH
5	372600000X	Adult Companion	2573301	OH
6	3747P1801X	Personal Care Attendant	2573301	OH
7	253Z00000X	In Home Supportive Care Agency	2573301	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2573301	OTHER	OH	OHIO DODD CONTRACT NUMBER

General Provider Information

NPI Number	:	1235726191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A MCLENDON

Provider Business Mailing Address
First Line	:	6281 MARSH WREN DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-6533
Country	:	US
Telephone Number	:	330-354-4531
Fax Number	:

Provider Business Practice Location Address
First Line	:	6281 MARSH WREN DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-6533
Country	:	US
Telephone Number	:	330-354-4531
Fax Number	:

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

Provider Enumeration Date	:	12/28/2020
Last Update Date	:	12/28/2020

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Directions to “ JOHN A MCLENDON ” Practice Location

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