Basic Information
| Provider Information | |||||||||
| NPI: | 1073872180 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THOMAS M BROWN, M.D.,PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 188 STATE ROAD 129 S | ||||||||
| Address2: | SUITE B | ||||||||
| City: | BATESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470067628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129335544 | ||||||||
| FaxNumber: | 8129322000 | ||||||||
| Practice Location | |||||||||
| Address1: | 188 STATE ROAD 129 S | ||||||||
| Address2: | SUITE B | ||||||||
| City: | BATESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470067628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129335544 | ||||||||
| FaxNumber: | 8129322000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2012 | ||||||||
| LastUpdateDate: | 05/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/SOLO PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 8129335544 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 01041510A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 200055610 | 05 | IN | MEDICAID |