MEDICARE: MR. TOMMIE L BISHOP

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	3104A0625X	Assisted Living Facility (Mental Illness)	101017	AK

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	:	1881287951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOMMIE L BISHOP

Provider Business Mailing Address
First Line	:	PO BOX 202056
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99520-2056
Country	:	US
Telephone Number	:	907-223-6377
Fax Number	:

Provider Business Practice Location Address
First Line	:	1533 LATOUCHE ST APT C
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99501-5588
Country	:	US
Telephone Number	:	907-272-6377
Fax Number	:	866-496-4107

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

Provider Enumeration Date	:	02/18/2021
Last Update Date	:	02/18/2021

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