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Organization
MEDICOM, INC
Active
Organization
MEDICOM, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENNY EARL THOMAS DO (OWNER/PHYSICIAL)
(573) 774-6279
Entity
Organization
Contact information
Practice address
215 NORTH ST, SUITE B, WAYNESVILLE, MO 65583-2553
(573) 774-6279
(573) 774-5626
Mailing address
PO BOX 4503, WAYNESVILLE, MO 65583-4503
(573) 774-6279
(573) 774-5626
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
07/06/2006
Last updated
12/18/2008
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