=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245352533
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS J SCHORY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2007
-----------------------------------------------------
Last Update Date | 04/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 910 WALLACE AVE STE 206
-----------------------------------------------------
City | LEITCHFIELD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42754-2408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-593-0352
-----------------------------------------------------
Fax | 270-259-3332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 910 WALLACE AVE STE 206
-----------------------------------------------------
City | LEITCHFIELD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42754-2408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-259-3035
-----------------------------------------------------
Fax | 270-259-3332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 41190
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------