Basic Information
| Provider Information | |||||||||
| NPI: | 1336102888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARCHER | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1322 BERKELEY CT | ||||||||
| Address2: | |||||||||
| City: | POWELL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430657809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148471898 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 477 COOPER RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430818054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146272000 | ||||||||
| FaxNumber: | 6142218869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0001X | 35065935A | OH | N | 207RA0002X | 35065935A | OH | N | 207RC0000X | 35065935A | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 060054384 | 01 | OH | RAILROAD MEDICARE | OTHER | 2501822 | 01 | OH | UNITED HEALTHCARE OF OHIO | OTHER | 289254 | 01 | BLACK LUNG | OTHER | 0956032 | 05 | OH | MEDICAID | 060054384 | 01 | RAILROAD MEDICARE | OTHER | 13716 | 01 | OH | NATIONWIDE HEALTH PLANS | OTHER | 366278 | 01 | OH | MEDIGAP BCBS | OTHER | 4559220 | 01 | CIGNA | OTHER | 00000000198947 | 01 | OH | ANTHEM BCBS | OTHER | 45592200005 | 01 | OH | CIGNA | OTHER |