Thomas A Slack (NPI# 1669433793, PAC ID# 6406035799) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is MAXILLOFACIAL SURGERY.
| Nation Provider ID (NPI) | 1669433793 |
| PAC ID by PECOS | 6406035799 |
| Professional Enrollment ID | I20110119000174 |
| Full Name | Thomas A Slack |
| Organization Legal Name | KALAMAZOO ORAL AND MAXILLOFACIAL SURGERY PC |
| Address |
3801 Glenkerry Ct Portage MI 49024-0718 |
| Phone Number | 2693231527 |
| Gender | M |
| Medical School | UNIVERSITY OF MICHIGAN SCHOOL OF DENTISTRY |
| Graduation Year | 1984 |
| Primary Specialty | MAXILLOFACIAL SURGERY |
| Group Practice PAC ID | 5092994384 |
| Number of Group Practice Members | 4 |
| Accepts Medicare Assignment | M |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 230017 | BRONSON METHODIST HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 3801 Glenkerry Ct, Portage, MI 49024-0718 | 2693231527 | KALAMAZOO ORAL AND MAXILLOFACIAL SURGERY PC |
| Organization Legal Name | KALAMAZOO ORAL AND MAXILLOFACIAL SURGERY PC |
| Physicians | 4 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| David Wilson | Maxillofacial Surgery | Kalamazoo Oral and Maxillofacial Surgery PC | 4019 W Main St, Suite 200, Kalamazoo, MI 49006-2798 |
| Kevin D Morse | Oral Surgery | Kalamazoo Oral and Maxillofacial Surgery PC | 3801 Glenkerry Ct, Portage, MI 49024-0718 |
| Christian L Kanar | Maxillofacial Surgery | Kalamazoo Oral and Maxillofacial Surgery PC | 3801 Glenkerry Ct, Portage, MI 49024-0718 |
| Street Address |
3801 GLENKERRY CT |
| City | PORTAGE |
| State | MI |
| Zip | 49024-0718 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kevin D Morse | Oral Surgery | Kalamazoo Oral and Maxillofacial Surgery PC | 3801 Glenkerry Ct, Portage, MI 49024-0718 |
| Christian L Kanar | Maxillofacial Surgery | Kalamazoo Oral and Maxillofacial Surgery PC | 3801 Glenkerry Ct, Portage, MI 49024-0718 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michael David Mccallister | Nurse Practitioner | Southern Michigan Pain Consultants PC | 3770 Glenkerry Ct, Portage, MI 49024-0700 |
| Christine A Berry | Audiologist | Three Rivers Health System Inc | 3850 Glenkerry Ct, Portage, MI 49024-0700 |
| Michael T Kolinski | Osteopathic Manipulative Medicine | Southern Michigan Pain Consultants PC | 3770 Glenkerry Ct, Portage, MI 49024-0700 |
| Matthew Lars Kuiper | Pain Management | Southern Michigan Pain Consultants PC | 3770 Glenkerry Ct, Portage, MI 49024-0700 |
| Alessandra R Chatson | Nurse Practitioner | Southern Michigan Pain Consultants PC | 3770 Glenkerry Ct, Portage, MI 49024-0700 |
| Barton W Wild | Pain Management | Southern Michigan Pain Consultants PC | 3770 Glenkerry Ct, Portage, MI 49024-0700 |
| Laythen Young | Physical Therapy | Southern Michigan Pain Consultants PC | 3770 Glenkerry Ct, Portage, MI 49024-0700 |
| Thomas Raymond Ulrich | Physician Assistant | Southern Michigan Pain Consultants PC | 3770 Glenkerry Ct, Portage, MI 49024-0700 |
| Joel L Bez | Pain Management | Southern Michigan Pain Consultants PC | 3770 Glenkerry Ct, Portage, MI 49024-0700 |
| Nancy Ambs | Nurse Practitioner | Southern Michigan Pain Consultants PC | 3770 Glenkerry Ct, Portage, MI 49024-0700 |
| Find all physicians in zip 49024 | |||
| City | PORTAGE |
| Zip Code | 49024 |
| Specialty | MAXILLOFACIAL SURGERY |
| City + Specialty | PORTAGE + MAXILLOFACIAL SURGERY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.