Organization
A D TOMAS MD LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA RANDOLPH (MANAGER - FINANCIAL SERVICES)
(888) 843-8475
Entity
Organization
Contact information
Practice address
1100 E NORRIS DRIVE DEPT OF PATHOLOGY, OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER, OTTAWA, IL 61350-1604
(815) 434-5500
(815) 434-2939
Mailing address
PO BOX 732, OTTAWA, IL 61350-0732
(888) 843-8475
(314) 849-6395
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036048141
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036048141
—
IL
01
—
060002218
RR MEDICARE
IL
01
—
5000298
BLUE SHIELD
IL
Enumeration date
12/27/2007
Last updated
06/27/2008
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