1568494631 NPI number — THOMAS D HODGKISS MD

Table of content: THOMAS D HODGKISS MD (NPI 1568494631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568494631 NPI number — THOMAS D HODGKISS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HODGKISS
Provider First Name:
THOMAS
Provider Middle Name:
D
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:
1568494631
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5683 S REX RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38119-3821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-350-0678
Provider Business Mailing Address Fax Number:
901-350-0677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5683 S REX RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38119-3821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-350-0678
Provider Business Practice Location Address Fax Number:
901-350-0677
Provider Enumeration Date:
07/07/2006

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: 2085R0202X , with the licence number:  13060 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: R4317 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 20801 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00115815 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 126458001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4004657 . This is a "BCBS TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3054578 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 96979 . This is a "BCBS AR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 207729021 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4615497 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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