Basic Information
| Provider Information | |||||||||
| NPI: | 1053767459 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUSCOMB | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10050 BRIDGE ST # 470 | ||||||||
| Address2: | |||||||||
| City: | TRUCKEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961610212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055690752 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10121 PINE AVE | ||||||||
| Address2: | |||||||||
| City: | TRUCKEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961614835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305876011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2016 | ||||||||
| LastUpdateDate: | 07/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A168545 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.