1770560989 NPI number — THOMAS M WHITTEN MD

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 1770560989 NPI number — THOMAS M WHITTEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITTEN
Provider First Name:
THOMAS
Provider Middle Name:
M
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:
1770560989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1060 S MAIN ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIPTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46072-8327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-675-9889
Provider Business Mailing Address Fax Number:
888-544-9037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1060 S MAIN ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIPTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46072-8327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-675-9889
Provider Business Practice Location Address Fax Number:
888-544-9037
Provider Enumeration Date:
12/29/2005

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:  01055526 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 202K00000X , with the licence number: 01055526A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 01055526A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000320783 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200356650 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q0089831 . This is a "SHO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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