MEDICARE: THOMAS P FORKS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	12215	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00138501	OTHER	MS	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	753068151	OTHER	MS	MS HEALTH PARTNERS
2	753068151	OTHER	MS	1ST CHOICE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4253992	OTHER	MS	AETNA
6	168390702	OTHER	MS	DEPARTMENT OF LABOR
7	753068151008	OTHER	MS	TRICARE
8	753068151	OTHER	MS	MS PHYSICIANS CARE NETWOR

General Provider Information

NPI Number	:	1164499190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS P FORKS DO

Provider Business Mailing Address
First Line	:	1151 N STATE ST
Second Line	:	SUITE 408
City	:	JACKSON
State	:	MS
Zip	:	39202-2407
Country	:	US
Telephone Number	:	601-292-4261
Fax Number	:	601-292-4262

Provider Business Practice Location Address
First Line	:	7275 S SIWELL RD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39272-9776
Country	:	US
Telephone Number	:	601-373-7722
Fax Number	:	601-373-7378

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	12/02/2010

Similar Medicare Providers

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Practice Location Address:

7275 S SIWELL RD
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39272-9776

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1407825987 — ROBERT JUDSON WILLIAMS ANP
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1134249253 — MEDICAL FOUNDATION OF CENTRAL MISSISSIPPI, INC
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1275825101 — MR. JULIAN RONN WALTERS DPT
Practice Location Address:

7273 S SIWELL RD
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1497111652 — STEPHANIE HOWARD PTA
Practice Location Address:

7273 S SIWELL RD
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39272-9776

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1093172157 — SARAH JOANNA MASON PA-C
Practice Location Address:

7275 S SIWELL RD
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Directions to “ THOMAS P FORKS DO” Practice Location

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