Basic Information
| Provider Information | |||||||||
| NPI: | 1073595757 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOSEY | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 442 WEST HIGH STREET | ||||||||
| Address2: | MIDWEST COMMUNITY HEALTH ASSOCIATES | ||||||||
| City: | BRYAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196364517 | ||||||||
| FaxNumber: | 4196366438 | ||||||||
| Practice Location | |||||||||
| Address1: | 442 WEST HIGH STREET | ||||||||
| Address2: | MIDWEST COMMUNITY HEALTH ASSOCIATES | ||||||||
| City: | BRYAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196364517 | ||||||||
| FaxNumber: | 4196366438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 04/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35075250L | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2133533 | 05 | OH | MEDICAID |