MEDICARE: JAMES MASON KELL

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	376J00000X	Homemaker

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	:	1083221709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES MASON KELL

Provider Business Mailing Address
First Line	:	2661 NOTTINGHAM RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-1121
Country	:	US
Telephone Number	:	614-940-3480
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 HILO LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-3627
Country	:	US
Telephone Number	:	614-940-3481
Fax Number	:

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

Provider Enumeration Date	:	09/27/2020
Last Update Date	:	09/27/2020

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Directions to “ JAMES MASON KELL ” Practice Location

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