MEDICARE: MANDY L CALDWELL

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

General Provider Information

NPI Number	:	1750073557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY L CALDWELL

Provider Business Mailing Address
First Line	:	2023 SUNSET BLVD
Second Line	:
City	:	STEUBENVILLE
State	:	OH
Zip	:	43952-1349
Country	:	US
Telephone Number	:	740-792-4012
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 STATE ROUTE 646
Second Line	:
City	:	RICHMOND
State	:	OH
Zip	:	43944-7958
Country	:	US
Telephone Number	:	330-407-0784
Fax Number	:

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

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/22/2023

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