MEDICARE: MR. THOMAS LEE MINNOE JR. RN

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	171M00000X	Case Manager/Care Coordinator	492311	NY

General Provider Information

NPI Number	:	1073837985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS LEE MINNOE JR. RN

Provider Business Mailing Address
First Line	:	1540 GRAY RD
Second Line	:
City	:	UNION SPRINGS
State	:	NY
Zip	:	13160-4100
Country	:	US
Telephone Number	:	315-237-2815
Fax Number	:	315-364-8147

Provider Business Practice Location Address
First Line	:	1540 GRAY RD
Second Line	:
City	:	UNION SPRINGS
State	:	NY
Zip	:	13160-4100
Country	:	US
Telephone Number	:	315-237-2815
Fax Number	:	315-364-8147

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

Provider Enumeration Date	:	03/22/2010
Last Update Date	:	03/22/2010

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