MEDICARE: PATRICK R MCCREARY 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	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN220411	OTHER	OH	DRIVER LICENSE

General Provider Information

NPI Number	:	1346983764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICK R MCCREARY INC.

Provider Business Mailing Address
First Line	:	1204 HOLLOWBROOK DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-1828
Country	:	US
Telephone Number	:	937-674-1020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1204 HOLLOWBROOK DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-1828
Country	:	US
Telephone Number	:	937-674-1020
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. PATRICK R MCCREARY I
Credential	:	GRADUATE SWM COLLEGE
Telephone Number	:	937-674-1020

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	04/27/2022

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