Basic Information
| Provider Information | |||||||||
| NPI: | 1033658117 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THOMAS MATHIAS D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6502 PARK BLVD N | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337813142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275415544 | ||||||||
| FaxNumber: | 7275468142 | ||||||||
| Practice Location | |||||||||
| Address1: | 6502 PARK BLVD N | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337813142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275415544 | ||||||||
| FaxNumber: | 7275468142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2017 | ||||||||
| LastUpdateDate: | 02/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | MATHIAS | ||||||||
| AuthorizedOfficialFirstName: | STEVIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7275415544 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS0006027 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | TI5B5 | 01 | FL | BLUE CROSS BLUE SHEILD | OTHER |