Provider Demographics
NPI:1245292341
Name:O'ROURKE, THOMAS PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PATRICK
Last Name:O'ROURKE
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 1:3035 N MANOR DR
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-3865
Mailing Address - Country:US
Mailing Address - Phone:812-882-4745
Mailing Address - Fax:
Practice Address - Street 1:700 WILLOW ST STE 203
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1029
Practice Address - Country:US
Practice Address - Phone:812-882-1000
Practice Address - Fax:812-882-1004
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041306A207V00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10015520AMedicaid
IN10015520AMedicaid
IN444210Medicare ID - Type Unspecified