MEDICARE: MR. TIM A BRANHAM RN

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	3747A0650X	Attendant Care Provider	324997	OH
2	3747P1801X	Personal Care Attendant	324997	OH

General Provider Information

NPI Number	:	1932404332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIM A BRANHAM RN

Provider Business Mailing Address
First Line	:	43753 COVERED BRIDGE RD
Second Line	:
City	:	VINTON
State	:	OH
Zip	:	45686-8540
Country	:	US
Telephone Number	:	740-669-8608
Fax Number	:

Provider Business Practice Location Address
First Line	:	43753 COVERED BRIDGE RD
Second Line	:
City	:	VINTON
State	:	OH
Zip	:	45686-8540
Country	:	US
Telephone Number	:	740-669-8608
Fax Number	:

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

Provider Enumeration Date	:	01/14/2011
Last Update Date	:	01/14/2011

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