MEDICARE: CARESTAR

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	302F00000X	Exclusive Provider Organization	RP008385	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	:	1942332069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARESTAR

Provider Business Mailing Address
First Line	:	3035 FALCON BRIDGE DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-5428
Country	:	US
Telephone Number	:	614-860-9307
Fax Number	:

Provider Business Practice Location Address
First Line	:	3035 FALCON BRIDGE DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-5428
Country	:	US
Telephone Number	:	614-860-9307
Fax Number	:

Authorized Official
Title or Position	:	LICENSE PRACTICAL NURSE
Name	:	MRS. RENEE LOUISE CANNING
Credential	:	LPN
Telephone Number	:	614-860-9307

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	03/24/2008

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Directions to “CARESTAR ” Practice Location

Language	Start Address	Practice Location

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