Provider Demographics
NPI:1346964483
Name:MCFERREN, MICHAEL SHANE (SOLE PROPRIETOR)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHANE
Last Name:MCFERREN
Suffix:
Gender:M
Credentials:SOLE PROPRIETOR
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:S
Other - Last Name:MCFERREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SOLE PROPRIETOR
Mailing Address - Street 1:1096 AUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-9118
Mailing Address - Country:US
Mailing Address - Phone:740-851-3156
Mailing Address - Fax:
Practice Address - Street 1:1096 AUSTIN RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-9118
Practice Address - Country:US
Practice Address - Phone:740-851-3156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRQ492128Medicaid