MEDICARE: RONALD LEE DAMPIER

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	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	061670	OTHER	FL	HOMEMAKING AND COMPANION

General Provider Information

NPI Number	:	1255975843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD LEE DAMPIER

Provider Business Mailing Address
First Line	:	8637 COBBLESTONE DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34945-5702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8637 COBBLESTONE DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34945-5702
Country	:	US
Telephone Number	:	772-204-1493
Fax Number	:

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

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	11/06/2019

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