Healthcare Provider Details

I. General information

NPI: 1174616221
Provider Name (Legal Business Name): THOME ENTERPRISE L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 JIM CLEMENTS WAY SUITE A
SELAH WA
98942
US

IV. Provider business mailing address

300 JIM CLEMENTS WAY SUITE A
SELAH WA
98942
US

V. Phone/Fax

Practice location:
  • Phone: 509-902-6062
  • Fax: 509-902-3996
Mailing address:
  • Phone: 509-902-6062
  • Fax: 509-902-3996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number601963838
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number601963838
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number601963838
License Number StateWA

VIII. Authorized Official

Name: ERIK MICKELSON
Title or Position: MANAGER
Credential:
Phone: 509-834-7411