Healthcare Provider Details

I. General information

NPI: 1265050330
Provider Name (Legal Business Name): KURTIS MCLENDON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KURTIS JEWELL

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 12/01/2020
Certification Date: 11/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6281 MARSH WREN DR
COLUMBUS OH
43230-6533
US

IV. Provider business mailing address

6281 MARSH WREN DR
COLUMBUS OH
43230-6533
US

V. Phone/Fax

Practice location:
  • Phone: 419-961-5104
  • Fax:
Mailing address:
  • Phone: 419-961-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number2573275
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number2573275
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number2573275
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number2573275
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number2573275
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number2573275
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: