Provider Demographics
NPI:1225208150
Name:RODERICK J. TOMPKINS JR MD PSC
Entity Type:Organization
Organization Name:RODERICK J. TOMPKINS JR MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:606-329-2888
Mailing Address - Street 1:PO BOX 1353
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1353
Mailing Address - Country:US
Mailing Address - Phone:606-329-2888
Mailing Address - Fax:606-329-2890
Practice Address - Street 1:613 23RD ST STE 440
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2885
Practice Address - Country:US
Practice Address - Phone:606-329-2888
Practice Address - Fax:606-329-2890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64328750Medicaid
OH2026757Medicaid
KY7384Medicare PIN