MEDICARE: KEIGHAN THOMAS

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	171M00000X	Case Manager/Care Coordinator		OH

General Provider Information

NPI Number	:	1578119145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEIGHAN THOMAS

Provider Business Mailing Address
First Line	:	2298 S CLAYTON RD
Second Line	:
City	:	FARMERSVILLE
State	:	OH
Zip	:	45325-9282
Country	:	US
Telephone Number	:	937-620-8401
Fax Number	:

Provider Business Practice Location Address
First Line	:	2298 S CLAYTON RD
Second Line	:
City	:	FARMERSVILLE
State	:	OH
Zip	:	45325-9282
Country	:	US
Telephone Number	:	937-620-8401
Fax Number	:

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

Provider Enumeration Date	:	08/10/2019
Last Update Date	:	08/10/2019

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Directions to “ KEIGHAN THOMAS ” Practice Location

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