Healthcare Provider Details

I. General information

NPI: 1730246463
Provider Name (Legal Business Name): THOMAS JOHN HEGARTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CLEVELAND ST
GREAT BEND KS
67530-3563
US

IV. Provider business mailing address

25894 280TH ST
RUSHMORE MN
56168-5106
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-5511
  • Fax: 620-792-5977
Mailing address:
  • Phone: 507-329-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberT-03795
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number04-36965
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number49536
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: