MEDICARE: DEBBIE C FANARY

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1922237510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE C FANARY

Provider Business Mailing Address
First Line	:	PO BOX 3003
Second Line	:
City	:	THOMASVILLE
State	:	NC
Zip	:	27361-3003
Country	:	US
Telephone Number	:	336-240-2759
Fax Number	:

Provider Business Practice Location Address
First Line	:	995 BLACK LAKE RD
Second Line	:
City	:	THOMASVILLE
State	:	NC
Zip	:	27360-9090
Country	:	US
Telephone Number	:	336-240-2759
Fax Number	:	336-475-2005

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

Provider Enumeration Date	:	07/06/2009
Last Update Date	:	07/06/2009

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