MEDICARE: KENRICK'S DEDICATED HOSPITALIST SERVICES

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	208M00000X	Hospitalist Physician

General Provider Information

NPI Number	:	1306493366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENRICK'S DEDICATED HOSPITALIST SERVICES

Provider Business Mailing Address
First Line	:	71 VISTA RIDGE DR
Second Line	:
City	:	SOUTH LEBANON
State	:	OH
Zip	:	45065-8755
Country	:	US
Telephone Number	:	513-508-8945
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 S EDWIN C MOSES BLVD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-3462
Country	:	US
Telephone Number	:	513-508-8945
Fax Number	:	513-494-3072

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KENRICK RICHARDSON
Credential	:	MD
Telephone Number	:	513-508-8945

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	08/23/2019

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