MEDICARE: MR. THOMAS FOSTER MARTIN JR. C.P.O

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	1744P3200X	Prosthetics Case Management	1245288745	SC

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	:	1083745558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS FOSTER MARTIN JR. C.P.O

Provider Business Mailing Address
First Line	:	1010 HOBBY LN
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-3547
Country	:	US
Telephone Number	:	864-224-5446
Fax Number	:	864-231-7374

Provider Business Practice Location Address
First Line	:	1113 N FANT ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-4819
Country	:	US
Telephone Number	:	864-225-1683
Fax Number	:	864-231-7374

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/09/2007

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