MEDICARE: MADISON C PROFFITT

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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1528889516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON C PROFFITT

Provider Business Mailing Address
First Line	:	14586 SALEM CHURCH RD
Second Line	:
City	:	MOUNT ORAB
State	:	OH
Zip	:	45154-9531
Country	:	US
Telephone Number	:	513-344-0051
Fax Number	:

Provider Business Practice Location Address
First Line	:	14586 SALEM CHURCH RD
Second Line	:
City	:	MOUNT ORAB
State	:	OH
Zip	:	45154-9531
Country	:	US
Telephone Number	:	513-344-0051
Fax Number	:

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

Provider Enumeration Date	:	10/22/2024
Last Update Date	:	10/22/2024

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Directions to “ MADISON C PROFFITT ” Practice Location

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