Organization
THOMAS H. NOLEN, D.P.M., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS H. NOLEN D.P.M. (PRESIDENT)
(618) 548-0057
Entity
Organization
Contact information
Practice address
1313 MAIN ST, MOUNT VERNON, IL 62864-3720
(618) 242-8662
(618) 242-4171
Mailing address
624 W MAIN ST, SALEM, IL 62881-1403
(618) 548-0057
(618) 548-9611
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016-004182
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004182
—
IL
01
—
60115194
BLUE CROSS / BLUE SHIELD OF ILLINOIS
IL
Enumeration date
11/24/2006
Last updated
05/15/2008
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