Basic Information
| Provider Information | |||||||||
| NPI: | 1669469060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 217 DOZIER BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295014090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436695162 | ||||||||
| FaxNumber: | 8436674573 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 E CHEVES ST | ||||||||
| Address2: | RADIOLOGY DEPARTMENT | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436695162 | ||||||||
| FaxNumber: | 8436674573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 11/22/2013 | ||||||||
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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 | 2085R0202X | 5647 | SC | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 5647 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085B0100X | 5647 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085D0003X | 5647 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging | 2085U0001X | 5647 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085N0700X | 5647 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | 5647 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | 5647 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0001X | 5647 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0205X | 5647 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Radiological Physics | 2085R0203X | 5647 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 207U00000X | 5647 | SC | N | Allopathic & Osteopathic Physicians | Nuclear Medicine |
ID Information
| ID | Type | State | Issuer | Description | 154758900 | 01 | SC | US DEPT OF LABOR | OTHER | 570525838 | 01 | SC | STANDARD TAX ID | OTHER | 06818 | 01 | NC | BCBS OF NC | OTHER | 056478 | 05 | SC | MEDICAID | 31717 | 01 | SC | MEDCOST | OTHER | 300020866 | 01 | SC | RAILROAD MEDICARE | OTHER | 8906818 | 01 | NC | NC MEDICAID | OTHER |