Provider Demographics
NPI:1104992544
Name:THOMAS H NELSON MD
Entity type:Organization
Organization Name:THOMAS H NELSON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-665-7741
Mailing Address - Street 1:17 QUAIL RDG
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-4000
Mailing Address - Country:US
Mailing Address - Phone:731-665-7741
Mailing Address - Fax:731-855-3273
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:TN
Practice Address - Zip Code:38369-9711
Practice Address - Country:US
Practice Address - Phone:731-665-7741
Practice Address - Fax:731-855-3273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X
TN29728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4134362OtherBCBS TN
TN3235325OtherMEDICARE TN
TN3235325Medicaid