MEDICARE: MEGEN SIMON

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	171M00000X	Case Manager/Care Coordinator	100591	OH

General Provider Information

NPI Number	:	1558816587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGEN SIMON

Provider Business Mailing Address
First Line	:	5400 EDALBERT DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-7604
Country	:	US
Telephone Number	:	513-741-3100
Fax Number	:	513-741-5686

Provider Business Practice Location Address
First Line	:	2146 FERGUSON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3720
Country	:	US
Telephone Number	:	513-741-3100
Fax Number	:	513-741-5686

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

Provider Enumeration Date	:	08/19/2016
Last Update Date	:	08/19/2016

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