MEDICARE: TARO AUGUSTUS KURUSU PHD

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	103TC0700X	Clinical Psychologist	PY8365	FL
2	103TC1900X	Counseling Psychologist	2316	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	680014816	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	4065356	OTHER	BCBS-TN
3	702017316	OTHER	CARITEN HEALTHCARE
4	476464000	OTHER	MAGELLAN
5	TN0102	OTHER	JOHNDEERE HEALTHCARE
6	4039014	OTHER	BLUE CROSS BLUE SHIELD
7	476464000	OTHER	AETNA

General Provider Information

NPI Number	:	1952385940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARO AUGUSTUS KURUSU PHD

Provider Business Mailing Address
First Line	:	6541 SPECKER AVE
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4263
Country	:	US
Telephone Number	:	719-526-7155
Fax Number	:

Provider Business Practice Location Address
First Line	:	6541 SPECKER AVE
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4263
Country	:	US
Telephone Number	:	719-526-7155
Fax Number	:

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	09/26/2022

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