MEDICARE: CARMIN TECUMSEH MHR

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		OK

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	:	1639473861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMIN TECUMSEH MHR

Provider Business Mailing Address
First Line	:	1803 S WOOD DR
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-6825
Country	:	US
Telephone Number	:	918-752-9024
Fax Number	:

Provider Business Practice Location Address
First Line	:	1803 S WOOD DR
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-6825
Country	:	US
Telephone Number	:	918-752-9024
Fax Number	:

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

Provider Enumeration Date	:	01/03/2011
Last Update Date	:	01/03/2011

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