Provider Demographics
NPI:1689763468
Name:THOMAS O HENLEY
Entity Type:Organization
Organization Name:THOMAS O HENLEY
Other - Org Name:HENLEY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AVE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-698-4200
Mailing Address - Street 1:1090 MCCALLIE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404
Mailing Address - Country:US
Mailing Address - Phone:423-698-4200
Mailing Address - Fax:423-629-8810
Practice Address - Street 1:1090 MCCALLIE AVENUE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-698-4200
Practice Address - Fax:423-629-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000482332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00528316AMedicaid
TN0082678OtherTENNCARE BLUECARE
TN0082678OtherBLUE CROSS BLUE SHIELD TN
TN0082678OtherBLUE CROSS BLUE SHIELD TN