Provider Demographics
NPI:1487651709
Name:GREENLEE, THOMAS H (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:GREENLEE
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 1:1401 HARRODSBURG RD
Mailing Address - Street 2:C100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-278-4960
Mailing Address - Fax:859-278-0033
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:C100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-278-4960
Practice Address - Fax:859-278-0033
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20773208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCF7805OtherRAILROAD MEDICARE
KYCJ2601OtherRAILROAD MEDICARE
KYCN8331OtherRAILROAD MEDICARE
KY64207731Medicaid
KY0542704Medicare PIN
KYP00363087Medicare PIN
KYCN8331OtherRAILROAD MEDICARE
KYC64579Medicare UPIN
KY64207731Medicaid