MEDICARE: CAROL L. MAGNUSON M.D.

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	208000000X	Pediatrics Physician	MD0000015928	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	3002741	OTHER		MEDICARE

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

General Provider Information

NPI Number	:	1417928730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL L. MAGNUSON M.D.

Provider Business Mailing Address
First Line	:	1701 N MAIN ST
Second Line	:	SUITE D
City	:	SHELBYVILLE
State	:	TN
Zip	:	37160-2303
Country	:	US
Telephone Number	:	931-685-4060
Fax Number	:	931-685-4062

Provider Business Practice Location Address
First Line	:	1701 N MAIN ST
Second Line	:	SUITE D
City	:	SHELBYVILLE
State	:	TN
Zip	:	37160-2303
Country	:	US
Telephone Number	:	931-685-4060
Fax Number	:	931-685-4062

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	11/05/2009

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