Active NPI
Paul Thurdekoos, MD
- Surgery Physician
- Johnson City, TN
National Provider Identifier
1437145687
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD12981
- Practice address
- 3 Professional Park Dr
Suite 31
Johnson City, TN 37604-6529 - Phone
- (423) 975-5650
- Fax
- (423) 975-5652
- NPI assigned
- Sep 23, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD12981 | TN | Primary |
Addresses
Primary practice location
3 Professional Park Dr
Suite 31
Johnson City, TN 37604-6529
Mailing address
3 Professional Park Dr
Suite 31
Johnson City, TN 37604-6529
Phone (423) 975-5650
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3184779 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD12981 | TN | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Frederick Health Hospital
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338940800000",
"number": "1437145687",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 PROFESSIONAL PARK DR",
"address_2": "SUITE 31",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376046529",
"telephone_number": "423-975-5650",
"fax_number": "423-975-5652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 PROFESSIONAL PARK DR",
"address_2": "SUITE 31",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376046529",
"telephone_number": "423-975-5650",
"fax_number": "423-975-5652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THURDEKOOS",
"first_name": "PAUL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-23",
"last_updated": "2012-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "TN",
"license": "MD12981",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3184779",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.