MEDICARE: DR. SHELLEY K BOONE MD

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	208100000X	Physical Medicine & Rehabilitation Physician	35.088642	OH
2	208100000X	Physical Medicine & Rehabilitation Physician	D71035	MD
3	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	35.088642	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942422274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLEY K BOONE MD

Provider Business Mailing Address
First Line	:	1643 W LANE AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-3339
Country	:	US
Telephone Number	:	614-775-1503
Fax Number	:

Provider Business Practice Location Address
First Line	:	1643 W LANE AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-3339
Country	:	US
Telephone Number	:	614-775-1503
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	11/15/2011

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