Provider Demographics
NPI:1811224504
Name:STEPHEN J. THOMAS MD, PC
Entity Type:Organization
Organization Name:STEPHEN J. THOMAS MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE'
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-642-2525
Mailing Address - Street 1:17600 SW ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4411
Mailing Address - Country:US
Mailing Address - Phone:503-642-2525
Mailing Address - Fax:503-649-9860
Practice Address - Street 1:17600 SW ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-4411
Practice Address - Country:US
Practice Address - Phone:503-642-2525
Practice Address - Fax:503-649-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08290207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR199430Medicaid
OR407002OtherBLUE CROSS
ORC94536OtherUPIN
OR0410790001OtherDMERC
WA15684OtherDEPARTMENT OF L & I