MEDICARE: THOMAS R PLACE 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	173000000X	Legal Medicine	04-27581	KS

General Provider Information

NPI Number	:	1588657720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS R PLACE MD

Provider Business Mailing Address
First Line	:	1133 COLLEGE AVE
Second Line	:	E-120
City	:	MANHATTAN
State	:	KS
Zip	:	66502-2770
Country	:	US
Telephone Number	:	785-539-7641
Fax Number	:	785-539-6852

Provider Business Practice Location Address
First Line	:	1133 COLLEGE AVE
Second Line	:	E-120
City	:	MANHATTAN
State	:	KS
Zip	:	66502-2770
Country	:	US
Telephone Number	:	785-539-7641
Fax Number	:	785-539-6852

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/08/2007

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