Provider Demographics
NPI:1750345211
Name:HELTON, THOMAS J IV (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:HELTON
Suffix:IV
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 LAMONT ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:423-979-3554
Practice Address - Street 1:809 LAMONT ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3554
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008388207R00000X
TN2880207RC0000X, 207RI0011X
NC2013-00012207RC0000X
KY03383207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ024552Medicaid
KY7100175060Medicaid
VA1750345211Medicaid
OH2576770Medicaid
KYK011070Medicare PIN
TN103I119418Medicare PIN
TN103IC39497Medicare PIN
OHI32516Medicare UPIN
OHHE7353111Medicare PIN