MEDICARE: THOMAS MULHOLLAN MD PA

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	291U00000X	Clinical Medical Laboratory

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649211020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS MULHOLLAN MD PA

Provider Business Mailing Address
First Line	:	PO BOX 1867
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76202-1867
Country	:	US
Telephone Number	:	940-384-6270
Fax Number	:	940-382-7680

Provider Business Practice Location Address
First Line	:	1600 SCRIPTURE ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-3809
Country	:	US
Telephone Number	:	940-384-6270
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MICHELLE SMITH
Credential	:
Telephone Number	:	940-384-6270

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	01/19/2012

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