Provider Demographics
NPI:1225212236
Name:A D TOMAS MD LTD
Entity Type:Organization
Organization Name:A D TOMAS MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER - FINANCIAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-843-8475
Mailing Address - Street 1:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-0732
Mailing Address - Country:US
Mailing Address - Phone:888-843-8475
Mailing Address - Fax:314-849-6395
Practice Address - Street 1:1100 E NORRIS DRIVE DEPT OF PATHOLOGY
Practice Address - Street 2:OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-1604
Practice Address - Country:US
Practice Address - Phone:815-434-5500
Practice Address - Fax:815-434-2939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048141207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5000298OtherBLUE SHIELD
IL036048141Medicaid
IL060002218OtherRR MEDICARE
IL036048141Medicaid