Basic Information
| Provider Information | |||||||||
| NPI: | 1306853700 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEATROUS | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 AFFLINK PL STE 100 | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354062289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053669740 | ||||||||
| FaxNumber: | 2053449992 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 SAINT LUKES DR | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361177102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342738877 | ||||||||
| FaxNumber: | 3342739733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 05/09/2019 | ||||||||
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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 | 2085R0001X | 19860 | AL | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 051008209 | 01 | AL | BCBS AL/MONT EAST | OTHER | 009905565 | 05 | AL | MEDICAID | 009914315 | 05 | AL | MEDICAID | 000008209 | 05 | AL | MEDICAID | 051008345 | 01 | AL | BCBS OF AL/SYLACAUGA | OTHER | 051511893 | 01 | AL | BCBS OF AL/MONT SOUTH | OTHER | 051512851 | 01 | AL | BCBS OF AL/SHELBY | OTHER | 51107953 | 01 | AL | BCBS OF AL/ANNISTON | OTHER |