MEDICARE: NUTRITIONAL CONCERNS, INC

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	172V00000X	Community Health Worker	F78220	OH
2	133V00000X	Registered Dietitian	LD.6525	OH

General Provider Information

NPI Number	:	1306163423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRITIONAL CONCERNS, INC

Provider Business Mailing Address
First Line	:	331 KENWOOD AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-4013
Country	:	US
Telephone Number	:	937-367-1291
Fax Number	:	937-648-9880

Provider Business Practice Location Address
First Line	:	4415 DAYTON LIBERTY RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-5903
Country	:	US
Telephone Number	:	937-268-6741
Fax Number	:	937-268-6804

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ALBERTA M SCRUGGS
Credential	:	L.D.
Telephone Number	:	937-367-1291

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	04/29/2010

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Directions to “NUTRITIONAL CONCERNS, INC ” Practice Location

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