Basic Information
| Provider Information | |||||||||
| NPI: | 1134137912 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STUBBS | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 MEDICAL PARK ROAD | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292036839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035455700 | ||||||||
| FaxNumber: | 8034344699 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 MEDICAL PARK ROAD SUITE 106 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292036839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035455700 | ||||||||
| FaxNumber: | 8034344699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 09/01/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | 39490 | NC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207V00000X | 000039490 | NC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VM0101X | 11316 | SC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207V00000X | 11316 | SC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1134137912 | 05 | NC | MEDICAID | 113166 | 05 | SC | MEDICAID | 80695 | 01 | NC | BCBS NC | OTHER | 7980695 | 05 | NC | MEDICAID |