Basic Information
| Provider Information | |||||||||
| NPI: | 1821282716 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CO OTC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 BRAINERD RD | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374113603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236970057 | ||||||||
| FaxNumber: | 4236489366 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 E ANDREW JOHNSON HWY | ||||||||
| Address2: | |||||||||
| City: | GREENEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377450948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235255073 | ||||||||
| FaxNumber: | 4235255349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2007 | ||||||||
| LastUpdateDate: | 12/07/2010 | ||||||||
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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 | 222Z00000X | C16007 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotist |
ID Information
| ID | Type | State | Issuer | Description | C16007 | 01 | BOC | OTHER | 1455062 | 05 | TN | MEDICAID | IO2135 | 01 | INT'L ASSOC. FOR ORTHOTIS | OTHER | 1507472 | 05 | TN | MEDICAID |