Provider Demographics
NPI:1093998098
Name:THOMAS E SPICER, MD-PC
Entity Type:Organization
Organization Name:THOMAS E SPICER, MD-PC
Other - Org Name:THOMAS E SPICER MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-362-8211
Mailing Address - Street 1:1208 HILLTOP DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5857
Mailing Address - Country:US
Mailing Address - Phone:307-362-8211
Mailing Address - Fax:
Practice Address - Street 1:1208 HILLTOP DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5857
Practice Address - Country:US
Practice Address - Phone:307-362-8211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2513A261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW308595OtherMEDICARE GROUP NUMBER
WYW308597OtherMEDICARE PROVIDER NUMBER
WY1103963600Medicaid
WY302359OtherBCBS PROVIDER NUMBER
WYA73043Medicare UPIN