MEDICARE: CRYSTAL FERGUSON

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	251E00000X	Home Health Agency

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

General Provider Information

NPI Number	:	1265821565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL FERGUSON

Provider Business Mailing Address
First Line	:	3452 VINE ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-1333
Country	:	US
Telephone Number	:	513-693-5952
Fax Number	:

Provider Business Practice Location Address
First Line	:	3452 VINE ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-1333
Country	:	US
Telephone Number	:	513-693-5952
Fax Number	:

Authorized Official
Title or Position	:	INDEPENDENT PROVIDER
Name	:	MISS CRYSTAL LEVETTE FERGUSON
Credential	:
Telephone Number	:	513-693-5952

Provider Enumeration Date	:	01/09/2015
Last Update Date	:	01/09/2015

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Directions to “CRYSTAL FERGUSON ” Practice Location

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