Provider Demographics
NPI:1366652661
Name:JOHN B THOMAS
Entity Type:Organization
Organization Name:JOHN B THOMAS
Other - Org Name:LAURELHURST FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-523-1545
Mailing Address - Street 1:4413 38TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5632
Mailing Address - Country:US
Mailing Address - Phone:206-523-1545
Mailing Address - Fax:206-523-1751
Practice Address - Street 1:4413 38TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5632
Practice Address - Country:US
Practice Address - Phone:206-523-1545
Practice Address - Fax:206-523-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017961261QP2300X
WAMD00023891261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7040868Medicaid
WA0173463OtherLABOR & INDUSTRIES
WA1016856Medicaid
WA17171OtherLABOR AND INDUSTRIES
WA1703503Medicaid
WA06802OtherLABOR AND INDUSTRIES
WA7040868Medicaid
WA1016856Medicaid
WAA06749Medicare UPIN