Provider Demographics
NPI:1164429825
Name:CHRISTENSEN, TOM A (MD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:A
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:AGAPE SENIOR PRIMARY CARE INC DBA MAIN STREET PHYSICIAN
Mailing Address - Street 2:1624 MAIN STREET
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2818
Mailing Address - Country:US
Mailing Address - Phone:803-726-2350
Mailing Address - Fax:803-753-9102
Practice Address - Street 1:3600 SEA MOUNTAIN HIGWAY
Practice Address - Street 2:SUITE C
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566
Practice Address - Country:US
Practice Address - Phone:843-399-4848
Practice Address - Fax:910-653-2346
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC18363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950176Medicaid
NC5950653Medicaid
NC0248HOtherNC BCBS
NC02787OtherNC BCBS
SC561243962OtherBCBS
NC080076269OtherRAILROAD MEDICARE
SC4770OtherSC MEDICARE
NC2315069OtherCIGNA MEDICARE
SCE03PA0Medicaid
NC0363OtherCIGNA MEDICARE
SC570941629OtherBCBS
SC561833405OtherSC BCBS
SCGP1062Medicaid
SCNPA648Medicaid
SCNPA648Medicaid