Healthcare Provider Details

I. General information

NPI: 1649377458
Provider Name (Legal Business Name): THOMAS JAMES MCKINNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 REID PARKWAY EMERGENCY DEPARTMENT
RICHMOND IN
47374-1157
US

IV. Provider business mailing address

1100 REID PARKWAY MEDICAL STAFF SERVICES
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-983-3144
  • Fax: 765-983-3038
Mailing address:
  • Phone: 765-983-0390
  • Fax: 765-983-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01052696
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: