MEDICARE: PAMELA THOGMARTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker		OR
2	175T00000X	Peer Specialist		OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124537824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA THOGMARTIN

Provider Business Mailing Address
First Line	:	371 PATRICIA LN
Second Line	:
City	:	EAGLE POINT
State	:	OR
Zip	:	97524-6619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	371 PATRICIA LN
Second Line	:
City	:	EAGLE POINT
State	:	OR
Zip	:	97524-6619
Country	:	US
Telephone Number	:	619-961-6554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2017
Last Update Date	:	04/05/2019

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Directions to “ PAMELA THOGMARTIN ” Practice Location

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