Provider Demographics
NPI:1326027103
Name:STYER, THOMAS B (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:STYER
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 409013
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9013
Mailing Address - Country:US
Mailing Address - Phone:800-377-8721
Mailing Address - Fax:304-523-2241
Practice Address - Street 1:625 JAMES S. TRIMBLE BLVD.
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1055
Practice Address - Country:US
Practice Address - Phone:606-789-3511
Practice Address - Fax:606-789-1432
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23196207P00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5490OtherMEDICARE GROUP
KY5491OtherMEDICARE GROUP
WV0104896-000Medicaid
KY8001OtherMEDICARE GROUP
930034855OtherRAILROAD
KY6649OtherMEDICARE GROUP
KY000000054162OtherBLUECROSS BLUESHIELD
OH0728583Medicaid
KY64231962Medicaid
OH0728583Medicaid
KY0664908Medicare PIN
C67999Medicare UPIN
WV0104896-000Medicaid
KY64231962Medicaid
KY000000054162OtherBLUECROSS BLUESHIELD