MEDICARE: FNU EKOBEMELLE SUBE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251X00000X	Supports Brokerage Agency
2	347C00000X	Private Vehicle
3	3747P1801X	Personal Care Attendant
4	376J00000X	Homemaker
5	376K00000X	Nurse's Aide
6	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1992404297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FNU EKOBEMELLE SUBE

Provider Business Mailing Address
First Line	:	4055 LEATHER STOCKING TRL
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-1528
Country	:	US
Telephone Number	:	614-592-6423
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 LEATHER STOCKING TRL
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-1528
Country	:	US
Telephone Number	:	614-592-6423
Fax Number	:

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

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

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Directions to “ FNU EKOBEMELLE SUBE ” Practice Location

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