Provider Demographics
NPI:1053519421
Name:TOMMY R. TIGAR, M.D., INC.
Entity type:Organization
Organization Name:TOMMY R. TIGAR, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:TIGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-289-2455
Mailing Address - Street 1:1150 PRATT RD
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107-8777
Mailing Address - Country:US
Mailing Address - Phone:937-383-0643
Mailing Address - Fax:
Practice Address - Street 1:341 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45113
Practice Address - Country:US
Practice Address - Phone:937-289-2455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074055T174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2149099Medicaid
OHG94967Medicare UPIN
OH2149099Medicaid