Basic Information
| Provider Information | |||||||||
| NPI: | 1326051129 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | GE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | THOMAS | ||||||||
| OtherFirstName: | MICHAEL | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1400 E. KINCAID STREET | ||||||||
| Address2: | ATTN: CREDENTIALING | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982744127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604282500 | ||||||||
| FaxNumber: | 3604286485 | ||||||||
| Practice Location | |||||||||
| Address1: | 2320 FREEWAY DRIVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608146800 | ||||||||
| FaxNumber: | 3608146917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 207X00000X | MD185536 | OR | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD00035605 | WA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 7573047 | 01 | AETNA | OTHER | BT5631521 | 01 | DEA | OTHER | 1104959 | 05 | WA | MEDICAID | 230400 | 01 | WA | LABOR & INDUSTRIES | OTHER | 2512TH | 01 | REGENCE | OTHER | 8951289 | 01 | WA | L&I CRIME VICTIMS COMPENSATION PROGRAM | OTHER | 8226870 | 05 | WA | MEDICAID | P00626752 | 01 | RAILROAD MEDICARE | OTHER | TH0246 | 01 | WA | BLUE SHIELD | OTHER | 124120 | 01 | WA | LABOR & INDUSTRY | OTHER |