Provider Demographics
NPI:1053347856
Name:ECKERT, THOMAS C (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:ECKERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3395
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47732-3395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1373 E STATE ROAD 62 STE 1C
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-7328
Practice Address - Country:US
Practice Address - Phone:812-801-0832
Practice Address - Fax:812-801-0759
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030362A207R00000X
IN01030362207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1065583OtherPASSPORT
KY2434507000OtherPASSPORT ADVANTAGE
268222OtherFEDERAL BLACK LUNG
IN4414242OtherAETNA
KY64757289Medicaid
IN000000042200OtherANTHEM BCBS
IN100204710AMedicaid
IN42200OtherANTHEM
4414242OtherAETNA
KY64757289Medicaid
KY2434507000OtherPASSPORT ADVANTAGE