Provider Demographics
NPI:1922251123
Name:THACKER, THOMAS ALVIS (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALVIS
Last Name:THACKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-858-6655
Mailing Address - Fax:270-858-4607
Practice Address - Street 1:19 MEDICAL LOOP STE 3
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653-4382
Practice Address - Country:US
Practice Address - Phone:606-376-5391
Practice Address - Fax:606-376-3326
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04885207Q00000X
TNDO0000003582207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine