MEDICARE: MR. ALBERT D SIMPSON JR.

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	376K00000X	Nurse's Aide	401441680912	OH

General Provider Information

NPI Number	:	1407191521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALBERT D SIMPSON JR.

Provider Business Mailing Address
First Line	:	392 E 160TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-1612
Country	:	US
Telephone Number	:	216-288-0858
Fax Number	:	216-531-3911

Provider Business Practice Location Address
First Line	:	392 E 160TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-1612
Country	:	US
Telephone Number	:	216-288-0858
Fax Number	:	216-531-3911

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

Provider Enumeration Date	:	11/29/2012
Last Update Date	:	11/29/2012

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