| Thad Vickery, MD | |
|
1200 El Camino Real, South San Francisco, CA 94080-3208 | |
| (650) 742-2000 | |
| Not Available |
| Full Name | Thad Vickery |
|---|---|
| Gender | Male |
| Speciality | Otolaryngology |
| Location | 1200 El Camino Real, South San Francisco, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689106957 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Y00000X | Otolaryngology | A161158 (California) | Primary |
| Entity Name | Permanente Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710 |
| Mailing Address | Practice Location Address |
|---|---|
| Thad Vickery, MD 1800 Harrison St Fl 7, Oakland, CA 94612-3466 Ph: (510) 625-6262 | Thad Vickery, MD 1200 El Camino Real, South San Francisco, CA 94080-3208 Ph: (650) 742-2000 |
Ramona Q. Fung, MD Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 1200 El Camino Real, South San Francisco, CA 94080 Phone: 650-742-2000 | |
James A. Nimmo, MD Otolaryngology Medicare: Not Enrolled in Medicare Practice Location: 1200 El Camino Real, South San Francisco, CA 94080 Phone: 650-742-2000 | |
Charles H. Vincent, MD Otolaryngology Medicare: Not Enrolled in Medicare Practice Location: 1200 El Camino Real, South San Francisco, CA 94080 Phone: 650-742-2000 | |
Adriane P. Concus, MD Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 1200 El Camino Real, South San Francisco, CA 94080 Phone: 650-742-2000 |