Provider Demographics
NPI:1417367962
Name:DR TOM CONBOY, INC
Entity Type:Organization
Organization Name:DR TOM CONBOY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CONBOY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:205-821-1607
Mailing Address - Street 1:1200 14TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-4907
Mailing Address - Country:US
Mailing Address - Phone:205-821-1607
Mailing Address - Fax:
Practice Address - Street 1:1200 14TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-4907
Practice Address - Country:US
Practice Address - Phone:205-821-1607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL555261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health