MEDICARE: ATM TCM AGENCY

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	251S00000X	Community/Behavioral Health Agency
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1396088589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATM TCM AGENCY

Provider Business Mailing Address
First Line	:	1310 W COLONIAL DR
Second Line	:	SUITE 18
City	:	ORLANDO
State	:	FL
Zip	:	32804-7139
Country	:	US
Telephone Number	:	407-405-5052
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 W COLONIAL DR
Second Line	:	SUITE 18
City	:	ORLANDO
State	:	FL
Zip	:	32804-7139
Country	:	US
Telephone Number	:	407-405-5052
Fax Number	:

Authorized Official
Title or Position	:	SUPERVISOR/MANAGING PARTNER
Name	:	MS. BRENDA THOMPSON
Credential	:
Telephone Number	:	407-405-5052

Provider Enumeration Date	:	04/05/2013
Last Update Date	:	04/05/2013

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