Healthcare Provider Details

I. General information

NPI: 1003841610
Provider Name (Legal Business Name): RHETT HUME TOMPKINS PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 MAIN ST SUITE 204
MENDOTA HEIGHTS MN
55118-3757
US

IV. Provider business mailing address

2209 TOTEM TRL
MINNETONKA MN
55305-2241
US

V. Phone/Fax

Practice location:
  • Phone: 651-528-8183
  • Fax: 651-528-8184
Mailing address:
  • Phone: 952-543-0729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9498
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: