1184255077 NPI number — THOMAS GEOFFREY EADE RPSGT, CCSH

Table of content: THOMAS GEOFFREY EADE RPSGT, CCSH (NPI 1184255077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184255077 NPI number — THOMAS GEOFFREY EADE RPSGT, CCSH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EADE
Provider First Name:
THOMAS
Provider Middle Name:
GEOFFREY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPSGT, CCSH
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:
1184255077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 PECAN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39042-8370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-606-8410
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 BROOKMAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKHAVEN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39601-2326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-835-9270
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2020

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: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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