Provider Demographics
NPI:1235159021
Name:TABB, THOMAS N (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:N
Last Name:TABB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:1301 PLEASANT VALLEY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9774
Practice Address - Country:US
Practice Address - Phone:270-417-7700
Practice Address - Fax:270-417-7705
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23651207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64779473Medicaid
IN200521690Medicaid
KY64779473Medicaid
KYK127181Medicare PIN
KY00533037/NORTONMedicare PIN
KY1275798Medicare ID - Type Unspecified
000000562033OtherANTHEM/NMFM
KY000023032ZOtherHUMANA/NMFM
KY3504583000OtherPAD/NMFM
KYA97142Medicare UPIN
KY0722528Medicare ID - Type UnspecifiedFOUNDATION
KY64779473Medicaid
KY64779473OtherMEDICAID/NMFM