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General NPI Number Information
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NPI Number | 1699963322
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Entity Type | Organization
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Legal Business Name | THOMAS C. THORNBERRY, M.D., LLC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 260 EVANS AVE
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City | MT STERLING
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State | KY
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Zip | 40353-9700
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Country | US
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Telephone | 859-498-7345
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Fax | 859-498-3780
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Provider Business Mailing Address
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Address Line | 260 EVANS AVE
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City | MT STERLING
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State | KY
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Zip | 40353-9700
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Country | US
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Telephone | 859-498-7345
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Fax | 859-498-3780
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS C THORNBERRY
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Credential | MD
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Telephone | 859-498-7345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 29071
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 29071
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License Number State | KY
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