MEDICARE: CHANNON SPURGEON

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	:	1235092883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANNON SPURGEON

Provider Business Mailing Address
First Line	:	9 CHESAPEAKE PLZ
Second Line	:
City	:	CHESAPEAKE
State	:	OH
Zip	:	45619-1003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 HIGHLAND DR
Second Line	:
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662
Country	:	US
Telephone Number	:	740-961-7972
Fax Number	:

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/19/2025

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Directions to “ CHANNON SPURGEON ” Practice Location

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