Provider Demographics
NPI:1144406596
Name:THOMAS F MCCLOSKEY
Entity Type:Organization
Organization Name:THOMAS F MCCLOSKEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCCLOSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:903-597-9622
Mailing Address - Street 1:1318 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2119
Mailing Address - Country:US
Mailing Address - Phone:903-597-9622
Mailing Address - Fax:903-597-1210
Practice Address - Street 1:1318 CLINIC DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2119
Practice Address - Country:US
Practice Address - Phone:903-597-9622
Practice Address - Fax:903-597-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0988213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6067310001Medicare NSC