1811224504 NPI number — STEPHEN J. THOMAS MD, PC

Table of content: (NPI 1811224504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811224504 NPI number — STEPHEN J. THOMAS MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN J. THOMAS 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:
1811224504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17600 SW ALEXANDER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALOHA
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97006-4411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-642-2525
Provider Business Mailing Address Fax Number:
503-649-9860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17600 SW ALEXANDER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALOHA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97006-4411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-642-2525
Provider Business Practice Location Address Fax Number:
503-649-9860
Provider Enumeration Date:
11/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SANSOM
Authorized Official First Name:
RENEE'
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BOOKKEEPER
Authorized Official Telephone Number:
503-642-2525

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  MD08290 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 199430 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 407002 . This is a "BLUE CROSS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: C94536 . This is a "UPIN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 0410790001 . This is a "DMERC" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 15684 . This is a "DEPARTMENT OF L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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