MEDICARE: MR. THOMAS A FIRTH MD

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	207R00000X	Internal Medicine Physician	MD15091	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110155238	OTHER	OR	RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1215936661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS A FIRTH MD

Provider Business Mailing Address
First Line	:	1445 GATEWAY BLVD
Second Line	:
City	:	COTTAGE GROVE
State	:	OR
Zip	:	97424-1224
Country	:	US
Telephone Number	:	541-942-7000
Fax Number	:	541-942-5550

Provider Business Practice Location Address
First Line	:	1445 GATEWAY BLVD
Second Line	:
City	:	COTTAGE GROVE
State	:	OR
Zip	:	97424-0026
Country	:	US
Telephone Number	:	541-942-7000
Fax Number	:	541-942-5550

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	12/20/2013

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