Provider Demographics
NPI:1306816673
Name:THOMAS B WHEELER MD PC
Entity Type:Organization
Organization Name:THOMAS B WHEELER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-621-5750
Mailing Address - Street 1:100 SCHUYLKILL MEDICAL PLZ
Mailing Address - Street 2:SUITE 201
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3663
Mailing Address - Country:US
Mailing Address - Phone:570-621-5750
Mailing Address - Fax:570-621-5755
Practice Address - Street 1:100 SCHUYLKILL MEDICAL PLZ
Practice Address - Street 2:SUITE 201
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3663
Practice Address - Country:US
Practice Address - Phone:570-621-5750
Practice Address - Fax:570-621-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA200039092OtherTRAVELERS MEDICARE
PA000720524OtherPA BLUE SHIELD
PA200039092OtherTRAVELERS MEDICARE
PA0723589Medicare PIN