Basic Information
| Provider Information | |||||||||
| NPI: | 1902943764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLEISCHHAUER | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | FRAZEE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 MEDICAL CENTER DR | ||||||||
| Address2: | TRI-LAKES MEDICAL CENTER | ||||||||
| City: | BATESVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386068608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6625635611 | ||||||||
| FaxNumber: | 6625630155 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 MEDICAL CENTER DR | ||||||||
| Address2: | TRI-LAKES MEDICAL CENTER | ||||||||
| City: | BATESVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386068608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6625635611 | ||||||||
| FaxNumber: | 6625630155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 11/28/2007 | ||||||||
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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 | 207Q00000X | 33653 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 19602 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 20450 | 01 | NC | CIGNA | OTHER | 680029 | 01 | NC | FIRST HEALTH | OTHER | BCBS | 01 | NC | INDIV. | OTHER | 07258508 | 05 | MS | MEDICAID | 2118842 | 01 | NC | MAMSI | OTHER | 70036 | 01 | NC | PARTNERS | OTHER | 8932589 | 05 | NC | MEDICAID | C6798 | 01 | NC | MEDCOST | OTHER |