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NPI Code Detail

MEDICARE: MR. MICHAEL MASON

MEDICARE: MR. MICHAEL MASON
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
1163W00000XRegistered NurseRN.335725OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11790735462OTHEROHNPI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619441144
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL MASON
Provider Business Mailing Address
First Line : 40 W 4TH ST
Second Line :
City : MANSFIELD
State : OH
Zip : 44902-1206
Country : US
Telephone Number : 419-520-3853
Fax Number :
Provider Business Practice Location Address
First Line : 40 W 4TH ST
Second Line :
City : MANSFIELD
State : OH
Zip : 44902-1206
Country : US
Telephone Number : 419-520-3853
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2019
Last Update Date : 01/17/2019

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