MEDICARE: THOMAS R COUGHLIN JR. MD

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	207P00000X	Emergency Medicine Physician	2005020196	MO

General Provider Information

NPI Number	:	1174505580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS R COUGHLIN JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 838
Second Line	:
City	:	SHAWNEE MISSION
State	:	KS
Zip	:	66201-0838
Country	:	US
Telephone Number	:	913-469-4244
Fax Number	:	913-469-1939

Provider Business Practice Location Address
First Line	:	1509 W TRUMAN RD
Second Line	:	EMERGENCY DEPARTMENT
City	:	INDEPENDENCE
State	:	MO
Zip	:	64050-3436
Country	:	US
Telephone Number	:	913-469-4244
Fax Number	:	913-469-1939

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

Provider Enumeration Date	:	11/19/2005
Last Update Date	:	07/08/2007

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