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General NPI Number Information
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NPI Number | 1710196951
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Entity Type | Organization
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Legal Business Name | WILLIAM T. THISTLETHWAITE M.D. PLLC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 1012C GLENVIEW DR
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City | GLASGOW
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State | KY
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Zip | 42141-3424
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Country | US
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Telephone | 270-629-3331
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Fax | 270-629-3330
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Provider Business Mailing Address
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Address Line | PO BOX 1147
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City | GLASGOW
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State | KY
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Zip | 42142
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Country | US
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Telephone | 270-629-3331
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Fax | 270-629-3330
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BECKY RUSSEL
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Credential |
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Telephone | 270-629-3331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 37101
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License Number State | KY
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