Provider Demographics
NPI:1679587778
Name:MCKNIGHT, THOMAS A (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:MCKNIGHT
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:PO BOX 11724
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4008
Mailing Address - Country:US
Mailing Address - Phone:402-721-7077
Mailing Address - Fax:402-753-6056
Practice Address - Street 1:350 W 23RD ST
Practice Address - Street 2:STE A
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2592
Practice Address - Country:US
Practice Address - Phone:402-721-7077
Practice Address - Fax:402-753-6056
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15494207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00243529OtherRR MR
NE10025238700Medicaid
NE07247OtherNE BCBS
P00243529OtherRR MR
NEB67824Medicare UPIN
NE07247OtherNE BCBS