Provider Demographics
NPI:1659585321
Name:THOMAS C WHITE MD PC
Entity Type:Organization
Organization Name:THOMAS C WHITE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-996-2800
Mailing Address - Street 1:200 W COUNTY LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2342
Mailing Address - Country:US
Mailing Address - Phone:303-996-2800
Mailing Address - Fax:303-470-9595
Practice Address - Street 1:200 W COUNTY LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2342
Practice Address - Country:US
Practice Address - Phone:303-996-2800
Practice Address - Fax:303-470-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22583207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO675089OtherBCBS PIN
CO46820078Medicaid
CO01225838Medicaid
COD49942Medicare UPIN
CO01225838Medicaid
COC804738Medicare PIN