1275528382 NPI number — THOMAS B TAN MD

Table of content: THOMAS B TAN MD (NPI 1275528382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275528382 NPI number — THOMAS B TAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAN
Provider First Name:
THOMAS
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275528382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4724 N DAVIS HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32503-2339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-696-4000
Provider Business Mailing Address Fax Number:
850-434-2647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RAPID CITY REGIONAL HOSPITAL
Provider Second Line Business Practice Location Address:
353 FAIRMONT BLVD.
Provider Business Practice Location Address City Name:
RAPID CITY
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-232-1165
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  17614 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: H2823 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 62467 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 109896 . This is a "AL MEDICAID- FOLEY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 110883 . This is a "AL MEDICAID- N DAVIS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 371163300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110905 . This is a "AL MEDICAID- WEST FLORIDA OFFICE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".