Provider Demographics
NPI:1790714046
Name:BASCOM, THOMAS H (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:BASCOM
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 RIVERBEND DR,.
Mailing Address - Street 2:SUITE 300 PEACEHEALTH SURGICAL SPECIALIES
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-8803
Mailing Address - Country:US
Mailing Address - Phone:541-222-8333
Mailing Address - Fax:541-222-8320
Practice Address - Street 1:3355 RIVERBEND DR.
Practice Address - Street 2:SUITE 300 PEACEHEALTH SURGICAL SPECIALIES
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8803
Practice Address - Country:US
Practice Address - Phone:541-222-8333
Practice Address - Fax:541-222-8320
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD17205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027834Medicaid
ORR0000WFBLLFMedicare PIN