Provider Demographics
NPI:1174541189
Name:HENIFF, THOMAS W (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:HENIFF
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 1:4835 LBJ FWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2605 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052
Practice Address - Country:US
Practice Address - Phone:214-506-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042775A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000586622OtherANTHEM PROVIDER NUMBER FOR ARNETT CLINIC, LLC
IN200028480Medicaid
IN200028480Medicaid
IN990600OMedicare PIN
INP00726209Medicare PIN
IN815500P1Medicare PIN