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Larissa Ann Thomas

Family Medicine

Allopathic & Osteopathic Physicians

2011 4th St, La Grande, OR 97850-2511

PECOS Enrollment

This provider is enrolled in PECOS as LARISSA THOMAS.

Based on the most recent information from CMS, provider Larissa Ann Thomas is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1720344393
Provider Type
Individual
Full Name
Thomas, Larissa Ann
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
4/7/2012
Last Updated
1/12/2023

Contact Information

Practice Location

2011 4th St, La Grande, OR 97850-2511

(541) 963-4139

(541) 429-6661

Mailing Location

PO Box 1517, Pendleton, OR 97801-0410

(877) 708-1119

(541) 278-8349

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License MD168475 Oregon

Provider Identifiers

ID	Description	Issuer
ID R184141	Description Other	Issuer MEDICARE PTAN PART A
ID R184162	Description Other	Issuer MEDICARE PTAN - PART B

Larissa Ann Thomas

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

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Kim R. Montee, M.D., P.C.

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