Provider Demographics
NPI:1649211020
Name:THOMAS MULHOLLAN MD PA
Entity Type:Organization
Organization Name:THOMAS MULHOLLAN MD PA
Other - Org Name:TJM MOLECULAR LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-384-6270
Mailing Address - Street 1:PO BOX 1867
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76202-1867
Mailing Address - Country:US
Mailing Address - Phone:940-384-6270
Mailing Address - Fax:940-382-7680
Practice Address - Street 1:1600 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3809
Practice Address - Country:US
Practice Address - Phone:940-384-6270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162087401Medicaid
OK200014670AMedicaid
TX162087401Medicaid
OK=========001OtherBCBS PIN
TX162087401Medicaid
OK800522334Medicare PIN