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NPI Code Detail

MEDICARE: OMETRICE SELMON

MEDICARE: OMETRICE SELMON
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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1285160507
Entity Type Code : Individual
Provider Name (Legal Business Name) : OMETRICE SELMON
Provider Business Mailing Address
First Line : 790 E 157TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44110-3037
Country : US
Telephone Number : 216-612-6618
Fax Number :
Provider Business Practice Location Address
First Line : 790 E 157TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44110-3037
Country : US
Telephone Number : 216-612-6618
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2017
Last Update Date : 05/05/2017

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Directions to “ OMETRICE SELMON ” Practice Location

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