Provider Demographics
NPI:1821707803
Name:MCGUFFIN, BRENT
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:
Last Name:MCGUFFIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 TOWNSHIP ROAD 1186 APT 35
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-6813
Mailing Address - Country:US
Mailing Address - Phone:740-861-1836
Mailing Address - Fax:
Practice Address - Street 1:223 TOWNSHIP ROAD 1186 APT 35
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-6813
Practice Address - Country:US
Practice Address - Phone:740-861-1836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care