MEDICARE: HENRY LEE THRASHER

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1285115089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY LEE THRASHER

Provider Business Mailing Address
First Line	:	3335 HAUCK ST APT 1036
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8024
Country	:	US
Telephone Number	:	725-201-2727
Fax Number	:

Provider Business Practice Location Address
First Line	:	3335 HAUCK ST APT 1036
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8024
Country	:	US
Telephone Number	:	725-201-2727
Fax Number	:

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

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	08/28/2018

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Directions to “ HENRY LEE THRASHER ” Practice Location

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