MEDICARE: DR. THOMAS HEWITT MCELROY DDS

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	1223P0700X	Prosthodontics	MO12922	MO

General Provider Information

NPI Number	:	1437113966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS HEWITT MCELROY DDS

Provider Business Mailing Address
First Line	:	8495 CRATER LAKE HWY
Second Line	:
City	:	WHITE CITY
State	:	OR
Zip	:	97503-3011
Country	:	US
Telephone Number	:	541-830-7455
Fax Number	:

Provider Business Practice Location Address
First Line	:	8495 CRATER LAKE HWY
Second Line	:
City	:	WHITE CITY
State	:	OR
Zip	:	97503-3011
Country	:	US
Telephone Number	:	541-830-7455
Fax Number	:

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	10/05/2014

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