MEDICARE: MR. JEFFREY M POLLY

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1154664258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY M POLLY

Provider Business Mailing Address
First Line	:	1501 MADISON ROAD 3RD FLOOR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2223
Country	:	US
Telephone Number	:	513-354-5310
Fax Number	:	513-354-5334

Provider Business Practice Location Address
First Line	:	1501 MADISON ROAD 3RD FLOOR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2223
Country	:	US
Telephone Number	:	513-354-5310
Fax Number	:	513-354-5334

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

Provider Enumeration Date	:	03/27/2013
Last Update Date	:	03/27/2013

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