| W Thomas Medical Llc | |
|
300 Executive Center Dr West Palm Beach FL 33401-4842 | |
| (561) 471-5566 | |
| Not Available |
| Full Name | W Thomas Medical Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 300 Executive Center Dr, West Palm Beach, Florida |
| Authorized Official Name and Position | Wallace Thomas (OWNER) |
| Authorized Official Contact | 5612013234 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| W Thomas Medical Llc 2784 Sw 129th Ter Miramar FL 33027-3852 Ph: (561) 201-3234 | W Thomas Medical Llc 300 Executive Center Dr West Palm Beach FL 33401-4842 Ph: (561) 471-5566 |
| NPI Number | 1801462858 |
|---|---|
| Provider Enumeration Date | 06/01/2021 |
| Last Update Date | 09/23/2021 |
| Medicare PECOS PAC ID | 2668873969 |
|---|---|
| Medicare Enrollment ID | O20210624000412 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801462858 | NPI | - | NPPES |
| 110589000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Inelisse Otero-diaz |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1952735862 PECOS PAC ID: 1557640661 Enrollment ID: I20161114000564 |
| Provider Name | Wallace Thomas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831490432 PECOS PAC ID: 1052607108 Enrollment ID: I20161229000763 |
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