Healthcare Provider Details

I. General information

NPI: 1568444974
Provider Name (Legal Business Name): THOMAS E. WELSH III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2005
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25117 HIGHWAY 15
UNION MS
39365-9088
US

IV. Provider business mailing address

PO BOX 2106
MERIDIAN MS
39302-2106
US

V. Phone/Fax

Practice location:
  • Phone: 601-774-8214
  • Fax: 601-774-8379
Mailing address:
  • Phone: 601-703-4331
  • Fax: 601-703-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number15061
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number15061
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15061
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: