Provider Demographics
NPI:1154426443
Name:THOMAS G. ALLEN M.D. P.C
Entity type:Organization
Organization Name:THOMAS G. ALLEN M.D. P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/M.D.
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-346-2620
Mailing Address - Street 1:950 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887-4310
Mailing Address - Country:US
Mailing Address - Phone:423-346-2620
Mailing Address - Fax:
Practice Address - Street 1:950 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-4310
Practice Address - Country:US
Practice Address - Phone:423-346-2620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000015065261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA98572Medicare UPIN
TN3021820Medicare ID - Type UnspecifiedMEDICARE/MEDICADE #