1710973516 NPI number — DR. TAMMY L THORE MD

Table of content: DR. TAMMY L THORE MD (NPI 1710973516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710973516 NPI number — DR. TAMMY L THORE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORE
Provider First Name:
TAMMY
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1710973516
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 HOSPITAL AVE STE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28640-9244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-246-7779
Provider Business Mailing Address Fax Number:
336-846-8370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 LUTHER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-846-3315
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2005

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: 208600000X , with the licence number:  35534 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7983237 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43058 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 83237 . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 11982 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 010345359 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 770000140 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 891046L , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5277206002 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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