MEDICARE: MR. RONALD CARRITHERS

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1871048850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD CARRITHERS

Provider Business Mailing Address
First Line	:	4595 W SPRING CREEK PKWY APT 3814
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-5249
Country	:	US
Telephone Number	:	901-870-2626
Fax Number	:

Provider Business Practice Location Address
First Line	:	4595 W SPRING CREEK PKWY APT 3814
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-5249
Country	:	US
Telephone Number	:	901-870-2626
Fax Number	:

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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