MEDICARE: DR. THOMAS E CHEYNE M.D.

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	207QS0010X	Sports Medicine (Family Medicine) Physician	C5734	AR

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	0464691	OTHER	AR	CIGNA
3	200038811	OTHER	AR	RAILROAD MEDICAE
4	0920084	OTHER	AR	UNITED HEALTHCARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	17637000000	OTHER	AR	QUALCHOICE
7	904221	OTHER	AR	USA MCO
8	4613344	OTHER	AR	AETNA
9	50998	OTHER	AR	ARKANSAS BLUE CROSS

General Provider Information

NPI Number	:	1144298845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS E CHEYNE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 11230
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72917-1230
Country	:	US
Telephone Number	:	479-709-6700
Fax Number	:	479-709-6751

Provider Business Practice Location Address
First Line	:	3501 WE KNIGHT DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6248
Country	:	US
Telephone Number	:	479-709-6700
Fax Number	:	479-709-6751

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	12/14/2009

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Directions to “ DR. THOMAS E CHEYNE M.D.” Practice Location

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