Pathom Thavaradhara MD PA

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

L8581 Issued in TX

Legal business name

PATHOM THAVARADHARA MD PA

Practice address

100 W 30TH Ave Ste 102
Pampa, TX 79065-2814

Phone

(806) 669-2900

Fax

(806) 669-2031

NPI assigned

Mar 24, 2008

Organization subpart

No

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

Authorized official

Name

Pathom Thavaradhara, MD

Title

President

Phone

(806) 669-2900

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216944000000",
    "number": "1861664435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W 30TH AVE STE 102",
            "city": "PAMPA",
            "state": "TX",
            "postal_code": "790652814",
            "telephone_number": "806-669-2900",
            "fax_number": "806-669-2031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W 30TH AVE STE 102",
            "city": "PAMPA",
            "state": "TX",
            "postal_code": "790652814",
            "telephone_number": "806-669-2900",
            "fax_number": "806-669-2031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOM THAVARADHARA MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-24",
        "last_updated": "2008-07-25",
        "status": "A",
        "authorized_official_last_name": "THAVARADHARA",
        "authorized_official_first_name": "PATHOM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "806-669-2900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "TX",
            "license": "L8581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "0012LM",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167272701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE, PALMETTO GBA",
            "identifier": "DD1161",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pampa Dental PLLC
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• Pampa Heart Clinic
• Pampa Isd
• Pampa Medical Development Associates Inc
• Teri A Pay, N.P.
• Jim Tom Pepper, RPH
• Minh Chau Thi Pham
• Phytex Rehabilitation, LLC
• Kristina Porter

• Pulmonary Disease Physician in Pampa, TX
• Providers in Pampa, TX by specialty
• Pulmonary Disease Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2008; 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.