MEDICARE: GARY ALLEN WEST

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
2	251E00000X	Home Health Agency		OH

General Provider Information

NPI Number	:	1962017806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY ALLEN WEST

Provider Business Mailing Address
First Line	:	43223 TOWNSHIP ROAD 296
Second Line	:
City	:	DRESDEN
State	:	OH
Zip	:	43821-9634
Country	:	US
Telephone Number	:	740-216-9973
Fax Number	:

Provider Business Practice Location Address
First Line	:	43223 TOWNSHIP ROAD 296
Second Line	:
City	:	DRESDEN
State	:	OH
Zip	:	43821-9634
Country	:	US
Telephone Number	:	740-823-2209
Fax Number	:

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

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	09/08/2020

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