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General NPI Number Information
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NPI Number | 1225015456
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Entity Type | Individual
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Provider Name | WILLIAM H THOM M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 400 MAPLE SUMMIT RD PAIN CENTER
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City | JERSEYVILLE
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State | IL
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Zip | 62052
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Country | US
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Telephone | 618-498-2273
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Fax | 618-498-8316
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Provider Business Mailing Address
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Address Line | 390 MAPLE SUMMIT RD
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City | JERSEYVILLE
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State | IL
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Zip | 62052-2000
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Country | US
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Telephone | 618-498-7518
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Fax | 618-498-3052
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 2004005755
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 036118645
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 036.118645
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License Number State | IL
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