MEDICARE: MEGAN ETHERIDGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	347C00000X	Private Vehicle
2	3747A0650X	Attendant Care Provider
3	376J00000X	Homemaker

General Provider Information

NPI Number	:	1467218222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN ETHERIDGE

Provider Business Mailing Address
First Line	:	11116 WADSWORTH AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-2259
Country	:	US
Telephone Number	:	216-377-9521
Fax Number	:

Provider Business Practice Location Address
First Line	:	11116 WADSWORTH AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-2259
Country	:	US
Telephone Number	:	216-377-9521
Fax Number	:

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

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	02/27/2024

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Directions to “ MEGAN ETHERIDGE ” Practice Location

Language	Start Address	Practice Location

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