MEDICARE: RICKIE BURTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	347C00000X	Private Vehicle
3	3747P1801X	Personal Care Attendant
4	376J00000X	Homemaker

General Provider Information

NPI Number	:	1427654557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICKIE BURTON

Provider Business Mailing Address
First Line	:	PO BOX 383
Second Line	:
City	:	SOUTH CHARLESTON
State	:	OH
Zip	:	45368-0383
Country	:	US
Telephone Number	:	937-462-7417
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 N. RANKIN ST.
Second Line	:
City	:	SOUTH CHARLESTON
State	:	OH
Zip	:	45368-4536
Country	:	US
Telephone Number	:	937-462-7417
Fax Number	:

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

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	12/04/2020

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Directions to “ RICKIE BURTON ” Practice Location

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