Basic Information
| Provider Information | |||||||||
| NPI: | 1568494631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HODGKISS | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5683 S REX RD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381193821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013500678 | ||||||||
| FaxNumber: | 9013500677 | ||||||||
| Practice Location | |||||||||
| Address1: | 5683 S REX RD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381193821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013500678 | ||||||||
| FaxNumber: | 9013500677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 04/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 13060 | MS | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | R4317 | AR | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 20801 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00115815 | 05 | MS | MEDICAID | 207729021 | 05 | MO | MEDICAID | 4615497 | 01 | AETNA | OTHER | 4004657 | 01 | TN | BCBS TN | OTHER | 126458001 | 05 | AR | MEDICAID | 96979 | 01 | AR | BCBS AR | OTHER | 3054578 | 05 | TN | MEDICAID |