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NPI Code Detail

MEDICARE: HENRY FULFORD

MEDICARE: HENRY FULFORD
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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215699558
Entity Type Code : Individual
Provider Name (Legal Business Name) : HENRY FULFORD
Provider Business Mailing Address
First Line : 445 E DUBLIN GRANVILLE RD
Second Line :
City : WORTHINGTON
State : OH
Zip : 43085-3192
Country : US
Telephone Number : 614-844-3800
Fax Number :
Provider Business Practice Location Address
First Line : 700 LIBERTY LN
Second Line :
City : DAYTON
State : OH
Zip : 45449-2135
Country : US
Telephone Number : 937-654-2814
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2021
Last Update Date : 10/13/2021

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Directions to “ HENRY FULFORD ” Practice Location

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