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NPI Code Detail

MEDICARE: MISTY THOMAS MSW

MEDICARE: MISTY THOMAS MSW
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1639132855
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTY THOMAS MSW
Provider Business Mailing Address
First Line : 720 N MARR RD
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-6660
Country : US
Telephone Number : 812-314-3400
Fax Number : 812-378-8367
Provider Business Practice Location Address
First Line : 1260 E BUCKEYE ST
Second Line :
City : NORTH VERNON
State : IN
Zip : 47265-8343
Country : US
Telephone Number : 812-346-4468
Fax Number : 812-346-4341
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2006
Last Update Date : 07/08/2007

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