Provider Demographics
NPI:1285270322
Name:MCCROSKEY, THOMAS MICHEAL JR (HIS)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MICHEAL
Last Name:MCCROSKEY
Suffix:JR
Gender:M
Credentials:HIS
Other - Prefix:MR
Other - First Name:THOMAS
Other - Middle Name:
Other - Last Name:MCCROSKEY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1737 POWDERSVILLE RD STE C5
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-8057
Mailing Address - Country:US
Mailing Address - Phone:864-436-1536
Mailing Address - Fax:
Practice Address - Street 1:1737 POWDERSVILLE RD STE C5
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-8057
Practice Address - Country:US
Practice Address - Phone:864-436-1536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC404237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1992141188OtherGROUP NPI
SC1316142342OtherORGANIZATION NPI