Individual ProviderAndrew CreadoreStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address101 The City Drive, City Tower, Ste 400, Orange, CA 92868(714) 456-5691(914) 462-1040PECOS EnrollmentBased on the most recent information from CMS, provider Andrew Creadore is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1477139327Provider TypeIndividualFull NameCreadore, AndrewCredentialMDGenderMaleSole ProprietorNoEnumeration Date3/22/2021Last Updated3/22/2021Contact InformationPractice LocationPractice Address101 The City Drive, City Tower, Ste 400, Orange, CA 92868Phone(714) 456-5691FaxUnlisted FaxMailing LocationMailing Address38 Kilsyth Rd Apt 33, Brookline, MA 02445-2066Phone(914) 462-1040FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer