MEDICARE: DR. THOMAS FONTENOT

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1689918328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. THOMAS FONTENOT

Provider Business Mailing Address
First Line	:	417 E LINCOLN RD
Second Line	:	SUITE A
City	:	VILLE PLATTE
State	:	LA
Zip	:	70586-3431
Country	:	US
Telephone Number	:	337-363-7744
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 E LINCOLN RD
Second Line	:	SUITE A
City	:	VILLE PLATTE
State	:	LA
Zip	:	70586-3431
Country	:	US
Telephone Number	:	337-363-7744
Fax Number	:

Authorized Official
Title or Position	:	CONSULTANT
Name	:	MRS. LORETTA FITZPATRICK
Credential	:
Telephone Number	:	770-943-5260

Provider Enumeration Date	:	11/19/2012
Last Update Date	:	11/19/2012

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