MEDICARE: DERRINGER FOOD SERVICES, 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	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1588989545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERRINGER FOOD SERVICES, INC.

Provider Business Mailing Address
First Line	:	5530 FAIR LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-3402
Country	:	US
Telephone Number	:	513-272-3480
Fax Number	:	513-272-2075

Provider Business Practice Location Address
First Line	:	5530 FAIR LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-3402
Country	:	US
Telephone Number	:	513-272-3480
Fax Number	:	513-272-2075

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MR. JACK EDWARD MAYBURY
Credential	:
Telephone Number	:	513-272-3480

Provider Enumeration Date	:	04/02/2010
Last Update Date	:	04/02/2010

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