MEDICARE: THOMAS M. NEVILLE 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	207Q00000X	Family Medicine Physician	35044664	OH
2	207Q00000X	Family Medicine Physician	54244	CO

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	:	1225099054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS M. NEVILLE M.D.

Provider Business Mailing Address
First Line	:	2930 11TH AVE
Second Line	:
City	:	EVANS
State	:	CO
Zip	:	80620-1011
Country	:	US
Telephone Number	:	970-350-4606
Fax Number	:	970-350-4645

Provider Business Practice Location Address
First Line	:	302 3RD ST SE
Second Line	:	SUITE 150
City	:	LOVELAND
State	:	CO
Zip	:	80537-6419
Country	:	US
Telephone Number	:	970-669-4855
Fax Number	:	970-669-7389

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	08/11/2015

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