Provider Demographics
NPI:1386218055
Name:THOMAS WATKINS, DO
Entity Type:Organization
Organization Name:THOMAS WATKINS, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:EARNEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-755-6038
Mailing Address - Street 1:855 OAKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4023
Mailing Address - Country:US
Mailing Address - Phone:231-755-6038
Mailing Address - Fax:231-747-9645
Practice Address - Street 1:855 OAKRIDGE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-4023
Practice Address - Country:US
Practice Address - Phone:231-755-6038
Practice Address - Fax:231-747-9645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1843599-11Medicaid