MEDICARE: THOMAS MCPHERSON RN

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	4704211016	MI

General Provider Information

NPI Number	:	1689062531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS MCPHERSON RN

Provider Business Mailing Address
First Line	:	8640 COCHISE DR
Second Line	:
City	:	HOWARD CITY
State	:	MI
Zip	:	49329-9304
Country	:	US
Telephone Number	:	616-318-7967
Fax Number	:

Provider Business Practice Location Address
First Line	:	8640 COCHISE DR
Second Line	:
City	:	HOWARD CITY
State	:	MI
Zip	:	49329-9304
Country	:	US
Telephone Number	:	616-318-7967
Fax Number	:

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

Provider Enumeration Date	:	12/30/2014
Last Update Date	:	12/30/2014

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