MEDICARE: DR. THOMAS W EADES M.D.

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	207RC0000X	Cardiovascular Disease Physician	E3550	TX
2	207RC0000X	Cardiovascular Disease Physician	6649	TN

General Provider Information

NPI Number	:	1558344432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS W EADES M.D.

Provider Business Mailing Address
First Line	:	1200 BROOKLYN AVE
Second Line	:	SUITE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4803
Country	:	US
Telephone Number	:	210-225-4566
Fax Number	:	210-212-2187

Provider Business Practice Location Address
First Line	:	1200 BROOKLYN AVE
Second Line	:	SUITE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4829
Country	:	US
Telephone Number	:	210-225-4566
Fax Number	:	210-212-2187

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	01/10/2008

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