MEDICARE: MILTON O MEDEIROS 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	174400000X	Specialist	7727	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00242733	OTHER	TN	RAILROAD MEDICARE NO

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	000000034150	OTHER	TN	TLC NO
4	4105401	OTHER	TN	BCBS OF TENNESSEE
5	000000165679	OTHER	TN	UNISON NO

General Provider Information

NPI Number	:	1366410599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILTON O MEDEIROS MD

Provider Business Mailing Address
First Line	:	3035 N HIGHLAND AVE
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3411
Country	:	US
Telephone Number	:	731-664-0899
Fax Number	:	731-664-0946

Provider Business Practice Location Address
First Line	:	3035 N HIGHLAND AVE
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3411
Country	:	US
Telephone Number	:	731-664-0899
Fax Number	:	731-664-0946

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/09/2007

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Directions to “ MILTON O MEDEIROS MD” Practice Location

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