1033342563 NPI number — THOMAS E. SPICER, MD, PC

Table of content: (NPI 1033342563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033342563 NPI number — THOMAS E. SPICER, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS E. SPICER, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033342563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1208 HILLTOP DR STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK SPRINGS
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82901-5858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-362-8211
Provider Business Mailing Address Fax Number:
307-382-3451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1208 HILLTOP DR STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK SPRINGS
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82901-5858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-362-8211
Provider Business Practice Location Address Fax Number:
307-382-3451
Provider Enumeration Date:
09/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SPICER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
307-362-8211

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  2513A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 24000693 . This is a "RAILROA MEDICARE GROUP NUMBER PTAN" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 18368920147 . This is a "KRIS SHERWIN, PA-C NPI NUMBER" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 1093998098 . This is a "THOMAS E. SPICER, MD GROUP NPI NUMBER" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 240000693 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: W308595 . This is a "MEDICARE GROUP" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: W308596 . This is a "KRIS SHERWIN PA-C MEDICARE NUMBER" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 103963600 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1821171349 . This is a "THOMAS E. SPICER NPI NUMBER" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: DN9829 . This is a "RAILROAD MEDICARE GROUP PTAN" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




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