MEDICARE: 3RD OPINION CO.

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	207Q00000X	Family Medicine Physician	37054	MN

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	:	1780992719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3RD OPINION CO.

Provider Business Mailing Address
First Line	:	PO BOX 607
Second Line	:
City	:	NEW LONDON
State	:	MN
Zip	:	56273-0607
Country	:	US
Telephone Number	:	320-347-1212
Fax Number	:	320-347-1200

Provider Business Practice Location Address
First Line	:	7900 CHAPIN DR NE
Second Line	:
City	:	NEW LONDON
State	:	MN
Zip	:	56273-8538
Country	:	US
Telephone Number	:	320-347-1212
Fax Number	:	320-347-1200

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/OWNER
Name	:	MR. THOMAS ALLEN SULT
Credential	:	MD
Telephone Number	:	320-347-1212

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	03/23/2015

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Directions to “3RD OPINION CO. ” Practice Location

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