1154336246 NPI number — SEAN R THOMAS MD, INC

Table of content: (NPI 1154336246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154336246 NPI number — SEAN R THOMAS MD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEAN R THOMAS MD, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMERICAN DESERT MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154336246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55585 29 PALMS HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUCCA VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92284-2505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-228-3366
Provider Business Mailing Address Fax Number:
760-228-3369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6186 ADOBE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWENTYNINE PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92277-2652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-361-8525
Provider Business Practice Location Address Fax Number:
760-361-8528
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAUTISTA
Authorized Official First Name:
JANUARIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACTS DIRECTOR
Authorized Official Telephone Number:
760-228-3366

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RHM53885G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com