Provider Demographics
NPI:1558471896
Name:YEAGLEY, THOMAS JOHN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:YEAGLEY
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 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3115
Mailing Address - Fax:812-235-9580
Practice Address - Street 1:1429 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1037
Practice Address - Country:US
Practice Address - Phone:812-242-3115
Practice Address - Fax:812-235-9580
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057264A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200425570Medicaid
IN200425570PMedicaid
INP00834965OtherRAILROAD MEDICARE
000000269727OtherANTHEM
IN200425570XMedicaid
P00026095OtherRAILROAD MCARE PALAMETTO
P00026095OtherRAILROAD MCARE PALAMETTO
IN192770UUUMedicare PIN
INP00834965OtherRAILROAD MEDICARE
IN200425570PMedicaid
IN859910AAAAMedicare PIN