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NPI Code Detail

MEDICARE: THOMAS RICHARDSON MACOM, DIPL. OM

MEDICARE: THOMAS RICHARDSON MACOM, DIPL. OM
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
1171100000XAcupuncturistAC372ME

General Provider Information

NPI Number : 1821383183
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS RICHARDSON MACOM, DIPL. OM
Provider Business Mailing Address
First Line : 2720 W MAIN ST
Second Line : 3B
City : RAPID CITY
State : SD
Zip : 57702-8128
Country : US
Telephone Number : 605-484-5516
Fax Number :
Provider Business Practice Location Address
First Line : 2720 W MAIN ST
Second Line : 3B
City : RAPID CITY
State : SD
Zip : 57702-8128
Country : US
Telephone Number : 605-484-5516
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2011
Last Update Date : 06/15/2011

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