Basic Information
| Provider Information | |||||||||
| NPI: | 1902878705 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THOMAS E MURRAY ET AL PTR | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | BRIARWOOD CLINIC, THE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3645 N BRIARWOOD LANE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473045337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652895520 | ||||||||
| FaxNumber: | 7652895840 | ||||||||
| Practice Location | |||||||||
| Address1: | 3645 N BRIARWOOD LANE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473045337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652895520 | ||||||||
| FaxNumber: | 7652895840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 08/11/2014 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MURRAY | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7652895520 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THOMAS E MURRAY ET AL PTR | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | EDD, HSPP | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 100468380 | 05 | IN | MEDICAID | 000000179679 | 01 | IN | ANTHEM BC BS | OTHER | 207238000 | 01 | IN | MAGELLAN | OTHER | 100468380A | 05 | IN | MEDICAID |