Provider Demographics
NPI:1982700035
Name:THOMAS J LOMIS, MD, INC. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:THOMAS J LOMIS, MD, INC. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOMIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-782-3255
Mailing Address - Street 1:15211 VANOWEN ST
Mailing Address - Street 2:SUITE # 208
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3606
Mailing Address - Country:US
Mailing Address - Phone:818-782-3255
Mailing Address - Fax:818-782-7026
Practice Address - Street 1:15211 VANOWEN ST
Practice Address - Street 2:SUITE # 208
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3606
Practice Address - Country:US
Practice Address - Phone:818-782-3255
Practice Address - Fax:818-782-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG836002086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G836001Medicaid
CAG57581Medicare UPIN
CA6695930001Medicare NSC
CA00G836001Medicaid