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NPI Code Detail

MEDICARE: CALLIE BLAIR THOMAS MHPP

MEDICARE: CALLIE BLAIR THOMAS MHPP
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1891019766
Entity Type Code : Individual
Provider Name (Legal Business Name) : CALLIE BLAIR THOMAS MHPP
Provider Business Mailing Address
First Line : 1205 HOLLY ST
Second Line :
City : JONESBORO
State : AR
Zip : 72401-3774
Country : US
Telephone Number : 501-661-0720
Fax Number :
Provider Business Practice Location Address
First Line : 613 N FISHER ST
Second Line :
City : JONESBORO
State : AR
Zip : 72401-2152
Country : US
Telephone Number : 501-661-0720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2010
Last Update Date : 03/22/2010

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Directions to “ CALLIE BLAIR THOMAS MHPP” Practice Location

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