MEDICARE: ARLANDO C DAY INDIVIDUAL CONTRACT

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	172A00000X	Driver

General Provider Information

NPI Number	:	1962160069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARLANDO C DAY INDIVIDUAL CONTRACT

Provider Business Mailing Address
First Line	:	7216 MISTY DAWN DR
Second Line	:
City	:	FOREST HILL
State	:	TX
Zip	:	76140-1941
Country	:	US
Telephone Number	:	817-353-4856
Fax Number	:

Provider Business Practice Location Address
First Line	:	7216 MISTY DAWN DR
Second Line	:
City	:	FOREST HILL
State	:	TX
Zip	:	76140-1941
Country	:	US
Telephone Number	:	817-353-4856
Fax Number	:

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

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	12/06/2021

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