MEDICARE: SAINT EVANS MEDICAL

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1992404271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT EVANS MEDICAL

Provider Business Mailing Address
First Line	:	4179 ARBURY LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-1704
Country	:	US
Telephone Number	:	347-469-4193
Fax Number	:

Provider Business Practice Location Address
First Line	:	4179 ARBURY LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-1704
Country	:	US
Telephone Number	:	347-469-4193
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. DEQUAN STANTON
Credential	:
Telephone Number	:	347-469-4193

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	02/27/2023

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Directions to “SAINT EVANS MEDICAL ” Practice Location

Language	Start Address	Practice Location

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