Provider Demographics
NPI:1821279969
Name:THOR MEDICAL ASSOCIATION
Entity Type:Organization
Organization Name:THOR MEDICAL ASSOCIATION
Other - Org Name:CEDAR HILL MEDICAL & SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-291-1531
Mailing Address - Street 1:1121 N JOE WILSON RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1430
Mailing Address - Country:US
Mailing Address - Phone:972-291-1531
Mailing Address - Fax:972-291-1646
Practice Address - Street 1:1121 N JOE WILSON RD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1430
Practice Address - Country:US
Practice Address - Phone:972-291-1531
Practice Address - Fax:972-291-1646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035630501Medicaid
TX0095KGOtherBLUE CROSS BLUE SHIELD
TX00Z566Medicare PIN