Provider Demographics
NPI:1508048752
Name:THOMAS P BATHRICK DO, PC
Entity Type:Organization
Organization Name:THOMAS P BATHRICK DO, PC
Other - Org Name:THOMAS P BATHRICK DO, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:BATHRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:574-234-0851
Mailing Address - Street 1:1432 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46613-3205
Mailing Address - Country:US
Mailing Address - Phone:574-234-0851
Mailing Address - Fax:574-234-7072
Practice Address - Street 1:1432 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46613-3205
Practice Address - Country:US
Practice Address - Phone:574-234-0851
Practice Address - Fax:574-234-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000736A207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN222130Medicare PIN