MEDICARE: MR. EDDY CARL MASON SR.

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	374U00000X	Home Health Aide	RM204754	OH

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	:	1770613440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDDY CARL MASON SR.

Provider Business Mailing Address
First Line	:	326NCOOPERAVE.
Second Line	:	APT#2
City	:	CINCINNATI
State	:	OH
Zip	:	45215-2921
Country	:	US
Telephone Number	:	513-769-3910
Fax Number	:

Provider Business Practice Location Address
First Line	:	326 N COOPER AVE
Second Line	:	APT#2
City	:	CINCINNATI
State	:	OH
Zip	:	45215-2921
Country	:	US
Telephone Number	:	513-769-3910
Fax Number	:

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/09/2007

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