MEDICARE: MR. JOHN LEDREW NEVILLE

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		OK

General Provider Information

NPI Number	:	1285190348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN LEDREW NEVILLE

Provider Business Mailing Address
First Line	:	3113 N MERIDIAN CT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73122-1416
Country	:	US
Telephone Number	:	405-831-9945
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 N CLASSEN BLVD STE E600
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6016
Country	:	US
Telephone Number	:	405-248-9200
Fax Number	:	405-248-9321

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

Provider Enumeration Date	:	02/13/2019
Last Update Date	:	02/13/2019

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