MEDICARE: MR. GARRY B STOVER III

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	374U00000X	Home Health Aide

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447385570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARRY B STOVER III

Provider Business Mailing Address
First Line	:	2001 MT CARMEL RD
Second Line	:
City	:	VINTON
State	:	OH
Zip	:	45686
Country	:	US
Telephone Number	:	740-245-9850
Fax Number	:	740-245-9852

Provider Business Practice Location Address
First Line	:	2001 MT CARMEL RD
Second Line	:
City	:	VINTON
State	:	OH
Zip	:	45686
Country	:	US
Telephone Number	:	740-245-9850
Fax Number	:	740-245-9852

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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