Provider Demographics
NPI:1003113861
Name:THOMAS M. GRIGGS MD PC
Entity Type:Organization
Organization Name:THOMAS M. GRIGGS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MCKAY
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-881-0284
Mailing Address - Street 1:1009 BROOK RIDGE CIR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-1404
Mailing Address - Country:US
Mailing Address - Phone:256-881-0284
Mailing Address - Fax:256-883-4434
Practice Address - Street 1:1009 BROOK RIDGE CIR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-1404
Practice Address - Country:US
Practice Address - Phone:256-881-0284
Practice Address - Fax:256-883-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAG6853174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000098510Medicaid
AL000098510GRIMedicare PIN
ALC71212Medicare UPIN