| Medicom, Inc | |
|
215 North St Suite B Waynesville MO 65583-2553 | |
| (573) 774-6279 | |
| (573) 774-5626 |
| Full Name | Medicom, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 215 North St, Waynesville, Missouri |
| Authorized Official Name and Position | Benny Earl Thomas (OWNER/PHYSICIAL) |
| Authorized Official Contact | 5737746279 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medicom, Inc Po Box 4503 Waynesville MO 65583-4503 Ph: (573) 774-6279 | Medicom, Inc 215 North St Suite B Waynesville MO 65583-2553 Ph: (573) 774-6279 |
| NPI Number | 1336171032 |
|---|---|
| Provider Enumeration Date | 07/06/2006 |
| Last Update Date | 12/18/2008 |
| Medicare PECOS PAC ID | 3476561358 |
|---|---|
| Medicare Enrollment ID | O20060404000455 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336171032 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Benny E Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316960115 PECOS PAC ID: 4183632060 Enrollment ID: I20060405000017 |
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