| Sean R Thomas Md, Inc | |
|
55585 29 Palms Hwy Yucca Valley CA 92284-2505 | |
| (760) 228-3366 | |
| (760) 228-3369 |
| Full Name | Sean R Thomas Md, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 55585 29 Palms Hwy, Yucca Valley, California |
| Authorized Official Name and Position | Januarie Bautisa (CONTRACTS DIRECTOR) |
| Authorized Official Contact | 7602283366 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sean R Thomas Md, Inc 55585 29 Palms Hwy Yucca Valley CA 92284-2505 Ph: (760) 228-3366 | Sean R Thomas Md, Inc 55585 29 Palms Hwy Yucca Valley CA 92284-2505 Ph: (760) 228-3366 |
| NPI Number | 1447476312 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 02/26/2015 |
| Medicare PECOS PAC ID | 6002899945 |
|---|---|
| Medicare Enrollment ID | O20121003000208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447476312 | NPI | - | NPPES |
| GR0089551 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A60305 (California) | Primary |
| 208000000X | Pediatrics | A60305 (California) | Secondary |
| Provider Name | Sean Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093725855 PECOS PAC ID: 5294718144 Enrollment ID: I20051227000662 |
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