Healthcare Provider Details

I. General information

NPI: 1245409002
Provider Name (Legal Business Name): MICHAEL THOMAS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 FRIST BLVD SUITE 709
HERMITAGE TN
37076-2054
US

IV. Provider business mailing address

5651 FRIST BLVD SUITE 709
HERMITAGE TN
37076-2054
US

V. Phone/Fax

Practice location:
  • Phone: 615-871-4904
  • Fax: 615-871-9682
Mailing address:
  • Phone: 615-871-4904
  • Fax: 615-871-9682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number13976MD
License Number StateTN

VIII. Authorized Official

Name: MICHAEL C THOMAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 615-871-4904