MEDICARE: LETINA THOMAS

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	2471C3401X	Computed Tomography Radiologic Technologist	383772	OH

General Provider Information

NPI Number	:	1891143475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETINA THOMAS

Provider Business Mailing Address
First Line	:	12500 WILLARD AVE
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-3626
Country	:	US
Telephone Number	:	216-338-5292
Fax Number	:

Provider Business Practice Location Address
First Line	:	12500 WILLARD AVE
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-3626
Country	:	US
Telephone Number	:	216-338-5292
Fax Number	:

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

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	05/24/2016

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Directions to “ LETINA THOMAS ” Practice Location

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