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NPI Code Detail

MEDICARE: PENNY ROSS

MEDICARE: PENNY ROSS
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1104323278
Entity Type Code : Individual
Provider Name (Legal Business Name) : PENNY ROSS
Provider Business Mailing Address
First Line : 660 S MAIN ST
Second Line :
City : DAYTON
State : OH
Zip : 45402-2708
Country : US
Telephone Number : 937-461-4800
Fax Number :
Provider Business Practice Location Address
First Line : 660 S MAIN ST
Second Line :
City : DAYTON
State : OH
Zip : 45402-2708
Country : US
Telephone Number : 937-461-4800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2018
Last Update Date : 04/06/2018

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Directions to “ PENNY ROSS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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