MEDICARE: DR. THOMAS J. HICKMAN 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	207V00000X	Obstetrics & Gynecology Physician	H6847	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669489126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS J. HICKMAN M.D.

Provider Business Mailing Address
First Line	:	5012 US HWY 75 S, SUITE 300
Second Line	:	ATT: BILLING
City	:	DENISON
State	:	TX
Zip	:	75020
Country	:	US
Telephone Number	:	806-351-7540
Fax Number	:	806-351-7546

Provider Business Practice Location Address
First Line	:	1900 SE 34TH AVE
Second Line	:	UNIT 1800
City	:	AMARILLO
State	:	TX
Zip	:	79118-7771
Country	:	US
Telephone Number	:	806-351-7540
Fax Number	:	806-351-7546

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	10/03/2017

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