MEDICARE: TOM CLINKENBEARD

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	376J00000X	Homemaker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639542988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOM CLINKENBEARD

Provider Business Mailing Address
First Line	:	2591 ELDORADO SPRINGS DR
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-5321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2591 ELDORADO SPRINGS DR
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-5321
Country	:	US
Telephone Number	:	970-391-6838
Fax Number	:

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

Provider Enumeration Date	:	11/09/2015
Last Update Date	:	12/18/2015

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Directions to “ TOM CLINKENBEARD ” Practice Location

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