MEDICARE: MR. SHAUN CONNOR THOMAS M.S

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1700311750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAUN CONNOR THOMAS M.S

Provider Business Mailing Address
First Line	:	79 WINSTON DR
Second Line	:	STE. #129
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-5768
Country	:	US
Telephone Number	:	307-922-2908
Fax Number	:

Provider Business Practice Location Address
First Line	:	79 WINSTON DR
Second Line	:	STE. #129
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-5768
Country	:	US
Telephone Number	:	307-922-2908
Fax Number	:

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

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	04/27/2017

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