Provider Demographics
NPI:1245409002
Name:MICHAEL THOMAS MD PC
Entity Type:Organization
Organization Name:MICHAEL THOMAS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-871-4904
Mailing Address - Street 1:5651 FRIST BLVD
Mailing Address - Street 2:SUITE 709
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2054
Mailing Address - Country:US
Mailing Address - Phone:615-871-4904
Mailing Address - Fax:615-871-9682
Practice Address - Street 1:5651 FRIST BLVD
Practice Address - Street 2:SUITE 709
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2054
Practice Address - Country:US
Practice Address - Phone:615-871-4904
Practice Address - Fax:615-871-9682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13976MD208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN125537291831OtherHUMANA
TNA98376OtherBEECH ST
TNA98376OtherFIRST HEALTH
TNA98376OtherTN CARE SELECT
TNA98376OtherGEHA
TN0007930OtherHEALTHSPRING
TNA98376OtherAMERICHOICE
TN1740238OtherUNITED HEALTHCARE
TN3020078Medicaid
TN01053986OtherAMERIGROUP
TN0056839OtherBCBS
TN681009OtherAETNA
TNA98376OtherGEHA
TN0007930OtherHEALTHSPRING
TN0056839OtherBCBS
TN1740238OtherUNITED HEALTHCARE
TN681009OtherAETNA
TN=========OtherMAIL HANDLERS
TN========= 0002OtherCIGNA