Basic Information
| Provider Information | |||||||||
| NPI: | 1205050002 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THRUSH | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 E SWAN ST | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370331417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317294271 | ||||||||
| FaxNumber: | 9317296793 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 E SWAN ST | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370331417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317294271 | ||||||||
| FaxNumber: | 9317296793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 03/30/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 18104 | TN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.