Healthcare Provider Details

I. General information

NPI: 1891544730
Provider Name (Legal Business Name): THOMAS MEDICAL INDEPENDENT CONTRACTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 COLUMBIA AVE E
BATTLE CREEK MI
49014-5159
US

IV. Provider business mailing address

1692 HAWLEY HWY
BELDING MI
48809-9518
US

V. Phone/Fax

Practice location:
  • Phone: 269-883-6052
  • Fax:
Mailing address:
  • Phone: 616-204-9679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: IAN S THOMAS
Title or Position: OWNER
Credential: MD
Phone: 616-204-9679