=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457389967
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL C THOMAS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2006
-----------------------------------------------------
Last Update Date | 09/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3901 CENTRAL PIKE SUITE 555
-----------------------------------------------------
City | HERMITAGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37076-3419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-874-9667
-----------------------------------------------------
Fax | 615-871-9682
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 356 24TH AVE N SUITE 300
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37203-1514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-292-5722
-----------------------------------------------------
Fax | 615-346-6225
-----------------------------------------------------
=====================================================
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 | 13976MD
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------