1932165610 NPI number — THOMAS A TRUMAN PA-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932165610 NPI number — THOMAS A TRUMAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUMAN
Provider First Name:
THOMAS
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1932165610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 N STATE OF FRANKLIN RD
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37604-6971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-431-2350
Provider Business Mailing Address Fax Number:
423-431-2372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 N STATE OF FRANKLIN RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-6971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-431-2350
Provider Business Practice Location Address Fax Number:
423-431-2372
Provider Enumeration Date:
04/22/2006

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: 363AS0400X , with the licence number:  PA00006 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: PA00006 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4074736 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: Q003380 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4074733 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN01R7 . This is a "JOHN DEERE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1932165610 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3665749 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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