MEDICARE: STEVEN O THOMAS 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	332900000X	Non-Pharmacy Dispensing Site	MD00015869	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4932477	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336360064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN O THOMAS MD

Provider Business Mailing Address
First Line	:	2207 N MOLTER RD
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-7570
Country	:	US
Telephone Number	:	509-473-5850
Fax Number	:	509-473-5500

Provider Business Practice Location Address
First Line	:	2207 N MOLTER RD
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-7570
Country	:	US
Telephone Number	:	509-473-5850
Fax Number	:	509-473-5500

Authorized Official
Title or Position	:	MANAGED CARE SPECIALIST
Name	:	DIRENDIA SHACKELFORD
Credential	:
Telephone Number	:	800-654-0889

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	01/25/2010

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Directions to “STEVEN O THOMAS MD ” Practice Location

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