=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164636841
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK H. THOMAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2580 SHILOH SPRINGS RD SUITE B
-----------------------------------------------------
City | TROTWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45426-2151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-837-5171
-----------------------------------------------------
Fax | 937-854-0400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2580 SHILOH SPRINGS RD SUITE B
-----------------------------------------------------
City | TROTWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45426-2151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-837-5171
-----------------------------------------------------
Fax | 937-854-0400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MARK H. THOMAS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 937-837-5171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 350 51593
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------