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NPI Code Detail

MEDICARE: ASHLIE M CORNELL CRIS RES SPEC

MEDICARE: ASHLIE M CORNELL CRIS RES SPEC
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
13747A0650XAttendant Care Provider

General Provider Information

NPI Number : 1265253108
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLIE M CORNELL CRIS RES SPEC
Provider Business Mailing Address
First Line : PO BOX 188
Second Line :
City : CHILLICOTHEE
State : OH
Zip : 45601-0188
Country : US
Telephone Number : 740-773-4366
Fax Number : 740-773-4750
Provider Business Practice Location Address
First Line : 100 WEST AVE
Second Line :
City : GALLIPOLIS
State : OH
Zip : 45631-1674
Country : US
Telephone Number : 740-446-5554
Fax Number : 740-446-8988
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2024
Last Update Date : 10/23/2024

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Directions to “ ASHLIE M CORNELL CRIS RES SPEC” Practice Location

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