Provider Demographics
NPI:1689768434
Name:MCRANEY, THOMAS OLIVER (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:OLIVER
Last Name:MCRANEY
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 1:1018 SIXTH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-3837
Mailing Address - Country:US
Mailing Address - Phone:601-799-1901
Mailing Address - Fax:601-799-1906
Practice Address - Street 1:1018 SIXTH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3837
Practice Address - Country:US
Practice Address - Phone:601-799-1901
Practice Address - Fax:601-799-1906
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00016244Medicaid
MS01-30218OtherUNITED HEALTHCARE MS
LA10538OtherBLUE CROSS BLUE SHIELD LA
LA1181102Medicaid
LA01-1002-8OtherUNITED HEALTHCARE LA
MS64-0615235OtherTAX EIN
LA1181102Medicaid
MS00016244Medicaid
GA083920510Medicare ID - Type UnspecifiedPALMETTO GBA, RAILROAD ME