MEDICARE: MEDICATION MANAGEMENT SPECIALISTS, LLC

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	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist

General Provider Information

NPI Number	:	1831425230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICATION MANAGEMENT SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 3024
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-0298
Country	:	US
Telephone Number	:	518-561-1603
Fax Number	:	518-561-0179

Provider Business Practice Location Address
First Line	:	3420 NW GREEN HILLS RD
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66618-1416
Country	:	US
Telephone Number	:	785-286-4461
Fax Number	:	785-246-1547

Authorized Official
Title or Position	:	MEMBER
Name	:	HAROLD HOGAN
Credential	:	ARNP
Telephone Number	:	785-286-4461

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	10/20/2009

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