MEDICARE: MELVIN WHITE MS

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1639689417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIN WHITE MS

Provider Business Mailing Address
First Line	:	3355 RICHMOND RD STE 225
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4180
Country	:	US
Telephone Number	:	216-831-1494
Fax Number	:

Provider Business Practice Location Address
First Line	:	3355 RICHMOND RD STE 225
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4180
Country	:	US
Telephone Number	:	216-831-1494
Fax Number	:

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

Provider Enumeration Date	:	10/05/2017
Last Update Date	:	10/05/2017

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