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General NPI Number Information
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NPI Number | 1689872830
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Entity Type | Individual
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Provider Name | THOMAS L PRIDDIS PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 429 NORTH PENNSYLVANIA STREET, SUITE 400
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-0001
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Country | US
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Telephone | 317-791-6691
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Fax | 317-791-6680
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Provider Business Mailing Address
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Address Line | 429 N PENNSYLVANIA ST SUITE 400
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-1815
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Country | US
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Telephone | 317-791-6691
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Fax | 317-791-6680
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10000934A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 10000934A
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License Number State | IN
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