Basic Information
| Provider Information | |||||||||
| NPI: | 1144298845 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEYNE | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11230 | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729171230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797096700 | ||||||||
| FaxNumber: | 4797096751 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 WE KNIGHT DR | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729036248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797096700 | ||||||||
| FaxNumber: | 4797096751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 12/14/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | C5734 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100076850A | 01 | OK | OKLAHOMA MEDICAID | OTHER | 0464691 | 01 | AR | CIGNA | OTHER | 200038811 | 01 | AR | RAILROAD MEDICAE | OTHER | 0920084 | 01 | AR | UNITED HEALTHCARE | OTHER | 101905001 | 05 | AR | MEDICAID | 17637000000 | 01 | AR | QUALCHOICE | OTHER | 904221 | 01 | AR | USA MCO | OTHER | 4613344 | 01 | AR | AETNA | OTHER | 50998 | 01 | AR | ARKANSAS BLUE CROSS | OTHER |