MEDICARE: MR. THOMAS A MAIBENCO 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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	336078668	IL
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	35295	OK

General Provider Information

NPI Number	:	1639211386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS A MAIBENCO MD

Provider Business Mailing Address
First Line	:	916 TALON DRIVE
Second Line	:	SUITE 102
City	:	OFALLON
State	:	IL
Zip	:	62269-1848
Country	:	US
Telephone Number	:	618-628-8211
Fax Number	:	618-628-0883

Provider Business Practice Location Address
First Line	:	1500 E DOWNING ST STE 101
Second Line	:
City	:	TAHLEQUAH
State	:	OK
Zip	:	74464-3354
Country	:	US
Telephone Number	:	918-453-1234
Fax Number	:

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	03/10/2020

Similar Medicare Providers

1982864054 — JAMEEL AMEER UQDAH M.D.
Practice Location Address:

1500 E DOWNING ST STE 101
TAHLEQUAH, OK
74464-3354

Practice Phone: 918-434-7440
Practice Fax:

1679770176 — RAJI M GILL DO PC
Practice Location Address:

1500 E DOWNING ST STE 100
TAHLEQUAH, OK
74464-3354

Practice Phone: 918-458-5700
Practice Fax: 918-458-5790

1285824045 — DR. KIMBERLY ANN MILFORD MD
Practice Location Address:

1500 E DOWNING ST STE 102
TAHLEQUAH, OK
74464-3354

Practice Phone: 918-207-0773
Practice Fax: 918-207-0774

1528253366 — JAMES R BRIXEY DO PC
Practice Location Address:

1500 E DOWNING ST , STE 101
TAHLEQUAH, OK
74464-3354

Practice Phone: 918-456-2549
Practice Fax: 918-456-3395

1891097077 — NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, INC
Practice Location Address:

1500 E DOWNING ST STE 102
TAHLEQUAH, OK
74464-3354

Practice Phone: 918-207-0773
Practice Fax: 918-207-0774

1740544428 — MUNEEZA AFIF MD
Practice Location Address:

1500 E DOWNING ST STE 101
TAHLEQUAH, OK
74464-3354

Practice Phone: 312-864-6000
Practice Fax:

Directions to “ MR. THOMAS A MAIBENCO MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.