Provider Demographics
NPI:1215328844
Name:DR JOSEPH S. THOMAS
Entity type:Organization
Organization Name:DR JOSEPH S. THOMAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:773-620-3022
Mailing Address - Street 1:9727 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1723
Mailing Address - Country:US
Mailing Address - Phone:773-881-3400
Mailing Address - Fax:773-881-0777
Practice Address - Street 1:9727 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1723
Practice Address - Country:US
Practice Address - Phone:773-881-3400
Practice Address - Fax:773-881-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068845261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068845Medicaid
ILD16544Medicare UPIN