Provider Demographics
NPI:1487852943
Name:THOMAS J. MELHAM, MD, LLC
Entity Type:Organization
Organization Name:THOMAS J. MELHAM, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MELHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-287-8596
Mailing Address - Street 1:2810 W ETHEL AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4402
Mailing Address - Country:US
Mailing Address - Phone:765-287-8596
Mailing Address - Fax:765-287-8593
Practice Address - Street 1:2810 W ETHEL AVE STE 5
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4402
Practice Address - Country:US
Practice Address - Phone:765-287-8596
Practice Address - Fax:765-287-8593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039790A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10784368OtherCAQH
IN000000337600OtherBLUE CROSS ANTHEM
IN1851495394OtherNPI PROVIDER
IN5646042OtherAETNA
IN5646042OtherAETNA
INF38128Medicare UPIN