MEDICARE: DR. THOMAS RICHEY 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	2085R0202X	Diagnostic Radiology Physician	10343	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300021477	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1780689166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS RICHEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1164
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30722-1164
Country	:	US
Telephone Number	:	706-271-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 AL HIGHWAY 69
Second Line	:
City	:	GUNTERSVILLE
State	:	AL
Zip	:	35976-7140
Country	:	US
Telephone Number	:	256-593-8310
Fax Number	:

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/09/2012

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