Provider Demographics
NPI:1902878705
Name:THOMAS E MURRAY ET AL PTR
Entity Type:Organization
Organization Name:THOMAS E MURRAY ET AL PTR
Other - Org Name:BRIARWOOD CLINIC, THE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, HSPP
Authorized Official - Phone:765-289-5520
Mailing Address - Street 1:3645 N BRIARWOOD LANE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5337
Mailing Address - Country:US
Mailing Address - Phone:765-289-5520
Mailing Address - Fax:765-289-5840
Practice Address - Street 1:3645 N BRIARWOOD LANE
Practice Address - Street 2:SUITE A
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5337
Practice Address - Country:US
Practice Address - Phone:765-289-5520
Practice Address - Fax:765-289-5840
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS E MURRAY ET AL PTR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-06
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100468380Medicaid
IN000000179679OtherANTHEM BC BS
IN207238000OtherMAGELLAN
IN100468380AMedicaid
IN190100Medicare PIN