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1518959865

NPI Code Detail

MEDICARE: THOMAS O'CONNELL MD

MEDICARE: THOMAS O'CONNELL MD

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	207R00000X	Internal Medicine Physician	33055	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P00935617	OTHER	KY	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	872928	OTHER		AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	021036000	OTHER		FEDERAL BLACK LUNG
4	0404223	OTHER		UNITED HEALTHCARE
5	000000044596	OTHER		ANTHEM
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	310674100	OTHER		US DEPT OF LABOR
8	50006692	OTHER		PASSPORT

General Provider Information

NPI Number	:	1518959865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS O'CONNELL MD

Provider Business Mailing Address
First Line	:	334 THOMAS MORE PKWY
Second Line	:	SUITE 200
City	:	CRESTVIEW HILLS
State	:	KY
Zip	:	41017-3464
Country	:	US
Telephone Number	:	859-341-0288
Fax Number	:	859-344-7482

Provider Business Practice Location Address
First Line	:	2900 CHANCELLOR DR
Second Line	:
City	:	CRESTVIEW HILLS
State	:	KY
Zip	:	41017-5427
Country	:	US
Telephone Number	:	859-341-0288
Fax Number	:	859-344-7482

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	08/01/2011

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Practice Location Address:

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1700878162 — CHRISTOPHER A HEEB MD
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1811989288 — TERRY A MCDANNOLD MD
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1982664264 — MARK STEPHEN MEIER MD
Practice Location Address:

2900 CHANCELLOR DR
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1881642734 — DR. ANGELO J COLOSIMO M.D.
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2900 CHANCELLOR DR STE 102
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1770531444 — THERESA R KOESTER MD
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Directions to “ THOMAS O'CONNELL MD” Practice Location

Language	Start Address	Practice Location

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