1215107826 NPI number — DR. SHERRI BERNIECE THOMAS DO

Table of content: DR. SHERRI BERNIECE THOMAS DO (NPI 1215107826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215107826 NPI number — DR. SHERRI BERNIECE THOMAS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
SHERRI
Provider Middle Name:
BERNIECE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STACEY
Provider Other First Name:
SHERRI
Provider Other Middle Name:
BERNIECE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215107826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6825 S 27TH ST
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68512-4872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-434-5235
Provider Business Mailing Address Fax Number:
402-489-2137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 S 70TH ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-441-4760
Provider Business Practice Location Address Fax Number:
402-441-4764
Provider Enumeration Date:
03/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  SL0532 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: R70145 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 1139 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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