Provider Demographics
NPI:1649377458
Name:MCKINNEY, THOMAS JAMES (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:MCKINNEY
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 1:1100 REID PARKWAY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-983-0390
Mailing Address - Fax:765-983-3219
Practice Address - Street 1:1100 REID PARKWAY
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-983-3144
Practice Address - Fax:765-983-3038
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052696207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200311510Medicaid
000000176016OtherANTHEM
000000176016OtherANTHEM
IN200311510Medicaid