Provider Demographics
NPI:1942529565
Name:THOMAS M FITZPATRICK MD LLC
Entity Type:Organization
Organization Name:THOMAS M FITZPATRICK MD LLC
Other - Org Name:MOUNTAIN SAGE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-573-7988
Mailing Address - Street 1:229 N EGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-1741
Mailing Address - Country:US
Mailing Address - Phone:541-573-7988
Mailing Address - Fax:888-371-1993
Practice Address - Street 1:229 N EGAN AVE
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-1741
Practice Address - Country:US
Practice Address - Phone:541-573-7988
Practice Address - Fax:888-371-1993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty