Provider Demographics
NPI:1134290703
Name:THOMAS W. FUTRELL,MD, PC
Entity Type:Organization
Organization Name:THOMAS W. FUTRELL,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:WALTER
Authorized Official - Last Name:FUTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-213-2240
Mailing Address - Street 1:907 GOOSE CREEK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2352
Mailing Address - Country:US
Mailing Address - Phone:540-213-2240
Mailing Address - Fax:540-213-2242
Practice Address - Street 1:907 GOOSE CREEK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2352
Practice Address - Country:US
Practice Address - Phone:540-213-2240
Practice Address - Fax:540-213-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058590207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006500056Medicaid
VA259524OtherANTHEM
VA040017242OtherMEDICARE RAILROAD
VA2689876008OtherCIGNA
VADG6012OtherMEDICARE RAILROAD GROUP
VA006500056OtherVIRGINIA PREMIER
VA157902OtherSOUTHERN HEALTH
VA24986OtherOPTIMA HEALTH
VA006500056Medicaid
VADG6012OtherMEDICARE RAILROAD GROUP
VA=========OtherVIRGINIA HEALTH NETWORK
VA259524OtherANTHEM
VA040000511Medicare ID - Type Unspecified