Basic Information
| Provider Information | |||||||||
| NPI: | 1457389967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 356 24TH AVE N | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152925722 | ||||||||
| FaxNumber: | 6153466225 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 CENTRAL PIKE | ||||||||
| Address2: | SUITE 555 | ||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370763419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158749667 | ||||||||
| FaxNumber: | 6158719682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 09/12/2011 | ||||||||
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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 | 208600000X | 13976MD | TN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 621278261 | 01 | TN CARE SELECT | OTHER | 621278261 | 01 | FIRST HEALTH | OTHER | 3020078 | 05 | TN | MEDICAID | 62127826137076A001 | 01 | TN | TRICARE | OTHER | 021101458 | 01 | MEDICARE RR | OTHER | 125537291831 | 01 | TN | HUMANA | OTHER | 1740238 | 01 | UNITED HEALTHCARE | OTHER | 0056839 | 01 | BCBS | OTHER | 007930 | 01 | TN | HEALTHSPRING | OTHER | 6212782610002 | 01 | TN | CIGNA | OTHER | 621278261 | 01 | BEECH ST | OTHER | 681009 | 01 | AETNA | OTHER |