MEDICARE: MARY ELLA THOMAS RN

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	163WH0200X	Home Health Registered Nurse	RN-291271	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2408362	OTHER	OH	INDEPENDENT PROVIDER #

General Provider Information

NPI Number	:	1295954915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELLA THOMAS RN

Provider Business Mailing Address
First Line	:	PO BOX 272034
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-8034
Country	:	US
Telephone Number	:	740-973-5131
Fax Number	:	614-948-1140

Provider Business Practice Location Address
First Line	:	5554 ALBANY SPRINGS DR
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-7001
Country	:	US
Telephone Number	:	740-973-5131
Fax Number	:	614-948-1140

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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