Basic Information
Provider Information | |||||||||
NPI: | 1801991062 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GREENE | ||||||||
FirstName: | THOMAS | ||||||||
MiddleName: | C | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 MEDICAL PARK BLVD | ||||||||
Address2: | 250 WEST | ||||||||
City: | BRISTOL | ||||||||
State: | TN | ||||||||
PostalCode: | 376207430 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4238446620 | ||||||||
FaxNumber: | 4238446627 | ||||||||
Practice Location | |||||||||
Address1: | 1 MEDICAL PARK BLVD | ||||||||
Address2: | 250 WEST | ||||||||
City: | BRISTOL | ||||||||
State: | TN | ||||||||
PostalCode: | 376207430 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4238446620 | ||||||||
FaxNumber: | 4238446627 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/13/2006 | ||||||||
LastUpdateDate: | 06/16/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 9039 | TN | Y |   | Allopathic & Osteopathic Physicians | Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 7355327 | 05 | VA |   | MEDICAID | 0075170 | 01 | TN | BCBS OF TENNESSEE | OTHER | 022276800 | 01 | TN | BLACK LUNG GROUP | OTHER | 3191927 | 05 | TN |   | MEDICAID | 4546131 | 01 | TN | AETNA | OTHER | F03906748 | 01 | TN | CHAMPUS GROUP | OTHER | 020029717 | 01 | TN | MCRAILROAD/GROUP#CA8128 | OTHER | 045124 | 01 | TN | INDIV ANTHEM/GROUP#093410 | OTHER | 0636398 | 01 | TN | UMWA GROUP | OTHER | TN0105 | 01 | TN | JOHN DEERE NOW UNITED HC | OTHER |