Provider Demographics
NPI:1164564639
Name:MILES, THOMAS JAMES (HEALTH SERVICES TECH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JAMES
Last Name:MILES
Suffix:
Gender:M
Credentials:HEALTH SERVICES TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 HUNTLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-3039
Mailing Address - Country:US
Mailing Address - Phone:314-269-2471
Mailing Address - Fax:314-269-2743
Practice Address - Street 1:1222 SPRUCE ST RM 2.102A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-2854
Practice Address - Country:US
Practice Address - Phone:314-269-2471
Practice Address - Fax:314-269-2743
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians