Basic Information
| Provider Information | |||||||||
| NPI: | 1225212236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | A D TOMAS MD LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 732 | ||||||||
| Address2: | |||||||||
| City: | OTTAWA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613500732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888438475 | ||||||||
| FaxNumber: | 3148496395 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 E NORRIS DRIVE DEPT OF PATHOLOGY | ||||||||
| Address2: | OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER | ||||||||
| City: | OTTAWA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613501604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154345500 | ||||||||
| FaxNumber: | 8154342939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2007 | ||||||||
| LastUpdateDate: | 06/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | RANDOLPH | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER - FINANCIAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 8888438475 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 036048141 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 5000298 | 01 | IL | BLUE SHIELD | OTHER | 036048141 | 05 | IL | MEDICAID | 060002218 | 01 | IL | RR MEDICARE | OTHER |