MEDICARE: DR. THOMAS LITTLE 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	207RI0011X	Interventional Cardiology Physician	MD19981	TN

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
2	4318732	OTHER	TN	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700823960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS LITTLE M.D.

Provider Business Mailing Address
First Line	:	228 W. 4TH STREET
Second Line	:	SUITE 200
City	:	COOKEVILLE
State	:	TN
Zip	:	38501
Country	:	US
Telephone Number	:	931-372-0405
Fax Number	:	931-372-0463

Provider Business Practice Location Address
First Line	:	228 W. 4TH STREET
Second Line	:	SUITE 200
City	:	COOKEVILLE
State	:	TN
Zip	:	38501
Country	:	US
Telephone Number	:	931-372-0405
Fax Number	:	931-372-0463

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	05/15/2017

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