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NPI Code Detail

MEDICARE: RODNEY DONNELL THOMAS BA, MHPP

MEDICARE: RODNEY DONNELL THOMAS BA, MHPP
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1295807295
Entity Type Code : Individual
Provider Name (Legal Business Name) : RODNEY DONNELL THOMAS BA, MHPP
Provider Business Mailing Address
First Line : PO BOX 15968
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72231-5968
Country : US
Telephone Number : 501-221-1843
Fax Number : 501-221-2376
Provider Business Practice Location Address
First Line : 4354 STOCKTON DR
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72117-2917
Country : US
Telephone Number : 501-955-7600
Fax Number : 501-955-7612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2006
Last Update Date : 08/27/2009

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