Provider Demographics
NPI:1154849008
Name:POLK, THOMAS
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:POLK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 S VINE ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5136
Mailing Address - Country:US
Mailing Address - Phone:740-550-2875
Mailing Address - Fax:
Practice Address - Street 1:431 S VINE ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-5136
Practice Address - Country:US
Practice Address - Phone:740-550-2875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide