Organization
THACKER FAMILY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY WAYNE THACKER MD (PRESIDENT)
(304) 743-8833
Entity
Organization
Contact information
Practice address
1155 MAIN ST, MILTON, WV 25541-1217
(304) 743-8833
(304) 743-8834
Mailing address
1155 MAIN ST, MILTON, WV 25541-1217
(304) 743-8833
(304) 743-8834
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0053746000
—
WV
05
—
0053757000
—
WV
05
—
0205283000
—
WV
Enumeration date
10/17/2006
Last updated
08/22/2020
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