Provider Demographics
NPI:1033342563
Name:THOMAS E. SPICER, MD, PC
Entity Type:Organization
Organization Name:THOMAS E. SPICER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-362-8211
Mailing Address - Street 1:1208 HILLTOP DR STE 103
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5858
Mailing Address - Country:US
Mailing Address - Phone:307-362-8211
Mailing Address - Fax:307-382-3451
Practice Address - Street 1:1208 HILLTOP DR STE 103
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5858
Practice Address - Country:US
Practice Address - Phone:307-362-8211
Practice Address - Fax:307-382-3451
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS E. SPICER, MD. PC AMBULATORY SURGERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2513A261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY24000693OtherRAILROA MEDICARE GROUP NUMBER PTAN
WY18368920147OtherKRIS SHERWIN, PA-C NPI NUMBER
WY1093998098OtherTHOMAS E. SPICER, MD GROUP NPI NUMBER
WY240000693OtherRAILROAD MEDICARE
WYW308595OtherMEDICARE GROUP
WYW308596OtherKRIS SHERWIN PA-C MEDICARE NUMBER
WY103963600Medicaid
WY1821171349OtherTHOMAS E. SPICER NPI NUMBER
WYDN9829OtherRAILROAD MEDICARE GROUP PTAN
WY24000693OtherRAILROA MEDICARE GROUP NUMBER PTAN
WYW308595OtherMEDICARE GROUP
WYA73043Medicare UPIN