Provider Demographics
NPI:1801991062
Name:GREENE, THOMAS C (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 MEDICAL PARK BLVD
Mailing Address - Street 2:250 WEST
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7430
Mailing Address - Country:US
Mailing Address - Phone:423-844-6620
Mailing Address - Fax:423-844-6627
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:250 WEST
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-6620
Practice Address - Fax:423-844-6627
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN9039208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7355327Medicaid
TN0075170OtherBCBS OF TENNESSEE
TN022276800OtherBLACK LUNG GROUP
TN3191927Medicaid
TN4546131OtherAETNA
TNF03906748OtherCHAMPUS GROUP
TN020029717OtherMCRAILROAD/GROUP#CA8128
TN045124OtherINDIV ANTHEM/GROUP#093410
TN0636398OtherUMWA GROUP
TNTN0105OtherJOHN DEERE NOW UNITED HC
TN4546131OtherAETNA
TN020029717OtherMCRAILROAD/GROUP#CA8128
TN103I022810Medicare PIN
TN3191922Medicare PIN
TN022276800OtherBLACK LUNG GROUP
TNB04493Medicare UPIN