Provider Demographics
NPI:1164636841
Name:MARK H. THOMAS
Entity Type:Organization
Organization Name:MARK H. THOMAS
Other - Org Name:FAMILY FIRST CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-837-5171
Mailing Address - Street 1:2580 SHILOH SPRINGS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2151
Mailing Address - Country:US
Mailing Address - Phone:937-837-5171
Mailing Address - Fax:937-854-0400
Practice Address - Street 1:2580 SHILOH SPRINGS RD
Practice Address - Street 2:SUITE B
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2151
Practice Address - Country:US
Practice Address - Phone:937-837-5171
Practice Address - Fax:937-854-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350 51593207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0685585Medicaid
OH0685585Medicaid
OHTH0619864Medicare ID - Type Unspecified