Thomas Vance Davis, D.O.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

0-173 Issued in ID

Practice address

1151 Hospital Way BLDG a
Pocatello, ID 83201-2763

Phone

(208) 232-6616

Fax

(208) 232-6618

NPI assigned

Jul 24, 2006

Last updated

Jan 27, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Endoscopy Center, LLC

  • Endoscopy Clinic/Center
  • Pocatello, ID
  • NPI 1770502767
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485475200000",
    "number": "1295757433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4788",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832054788",
            "telephone_number": "208-232-6616",
            "fax_number": "208-232-6618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 HOSPITAL WAY BLDG A",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012763",
            "telephone_number": "208-232-6616",
            "fax_number": "208-232-6618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "THOMAS",
        "middle_name": "VANCE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2017-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "ID",
            "license": "0-173",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "UT",
            "license": "10165949-8904",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002803100",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Sean Davis, LMSW
• Darrell Wade Davis, D.C.
• Gina Marie Davis, PHARM.D.
• Sage Davis, PHARMD
• Stephanie Ann Davis, MOTR/L
• Myla Day, LMSW
• Bo Dayton, DO
• Mary Ann Mendoza De Guzman, OT
• Robert Andrew De Wall, LCPC
• Justin Dechon

• Gastroenterology Physician in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Gastroenterology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.