Provider Demographics
NPI:1730246463
Name:HEGARTY, THOMAS JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:HEGARTY
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 1:25894 280TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSHMORE
Mailing Address - State:MN
Mailing Address - Zip Code:56168-5106
Mailing Address - Country:US
Mailing Address - Phone:507-329-2933
Mailing Address - Fax:
Practice Address - Street 1:204 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3563
Practice Address - Country:US
Practice Address - Phone:620-792-5511
Practice Address - Fax:620-792-5977
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-037952085R0001X
KS04-369652085R0001X
MN495362085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201089590AMedicaid
OK200577870AMedicaid
KS201089590BMedicaid
P01435075Medicare PIN
KSKA3434002Medicare PIN
KS201089590AMedicaid
KS16701013Medicare PIN