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NPI Code Detail

MEDICARE: MR. THOMAS BRADLEY COSGROVE CRNA

MEDICARE: MR. THOMAS BRADLEY COSGROVE CRNA
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
1367500000XCertified Registered Nurse AnesthetistR861282MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407803422
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THOMAS BRADLEY COSGROVE CRNA
Provider Business Mailing Address
First Line : PO BOX 7539
Second Line :
City : JACKSON
State : MS
Zip : 39284-7539
Country : US
Telephone Number : 601-376-1848
Fax Number : 601-376-1894
Provider Business Practice Location Address
First Line : 1850 CHADWICK DR
Second Line :
City : JACKSON
State : MS
Zip : 39204-3404
Country : US
Telephone Number : 601-376-1848
Fax Number : 601-376-1894
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2006
Last Update Date : 07/08/2007

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