MEDICARE: MR. STEVEN JON MCINNIS

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		ME

General Provider Information

NPI Number	:	1548309792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN JON MCINNIS

Provider Business Mailing Address
First Line	:	14 SMITHS LN
Second Line	:
City	:	HOLLIS CENTER
State	:	ME
Zip	:	04042-4029
Country	:	US
Telephone Number	:	207-929-3264
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 SMITHS LN
Second Line	:
City	:	HOLLIS CENTER
State	:	ME
Zip	:	04042-4029
Country	:	US
Telephone Number	:	207-929-3264
Fax Number	:

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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