Provider Demographics
NPI:1518983261
Name:MICAH TOMLINSON MD PA
Entity Type:Organization
Organization Name:MICAH TOMLINSON MD PA
Other - Org Name:MONTGOMERY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-597-5555
Mailing Address - Street 1:20873B EVA ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-1889
Mailing Address - Country:US
Mailing Address - Phone:936-597-5555
Mailing Address - Fax:936-597-5585
Practice Address - Street 1:20873B EVA ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-1889
Practice Address - Country:US
Practice Address - Phone:936-597-5555
Practice Address - Fax:936-597-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0074JLOtherBLUE CROSS
C22713Medicare UPIN
TX00608UMedicare PIN