MEDICARE: MEDTHRU

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	261QH0100X	Health Service Clinic/Center
2	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1477311819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDTHRU

Provider Business Mailing Address
First Line	:	6065 ROSWELL RD UPPR 150
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4034
Country	:	US
Telephone Number	:	732-598-6460
Fax Number	:

Provider Business Practice Location Address
First Line	:	6065 ROSWELL RD UPPR 150
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4034
Country	:	US
Telephone Number	:	678-642-7168
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	JENNA KAUFMAN
Credential	:
Telephone Number	:	732-598-6460

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	03/11/2024

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Directions to “MEDTHRU ” Practice Location

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