Provider Demographics
NPI:1528338795
Name:THOMAS E EIDSON, PLLC
Entity type:Organization
Organization Name:THOMAS E EIDSON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:EIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-795-7200
Mailing Address - Street 1:2705 W ARKANSAS LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-5818
Mailing Address - Country:US
Mailing Address - Phone:817-795-7200
Mailing Address - Fax:
Practice Address - Street 1:2705 W ARKANSAS LN
Practice Address - Street 2:SUITE A
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-5818
Practice Address - Country:US
Practice Address - Phone:817-795-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9698207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6725070001Medicare NSC