MEDICARE: THOMAS ROSS

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	231H00000X	Audiologist	A1198	MS

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	:	1447434642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS ROSS

Provider Business Mailing Address
First Line	:	PO BOX 753
Second Line	:
City	:	TCHULA
State	:	MS
Zip	:	39169-0753
Country	:	US
Telephone Number	:	662-235-5685
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 POPLAR ST
Second Line	:
City	:	TCHULA
State	:	MS
Zip	:	39169
Country	:	US
Telephone Number	:	662-235-5685
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THOMAS ROSS
Credential	:	AUDIOLOGIST
Telephone Number	:	662-235-5685

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	12/24/2007

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Directions to “THOMAS ROSS ” Practice Location

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