1447353347 NPI number — MS. ROBERTA M THOMAS ARNP

Table of content: MS. ROBERTA M THOMAS ARNP (NPI 1447353347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447353347 NPI number — MS. ROBERTA M THOMAS ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
ROBERTA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCTAGUE
Provider Other First Name:
ROBERTA
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447353347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
243 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAREMONT
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03743-4921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-863-6400
Provider Business Mailing Address Fax Number:
603-863-7800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 MAIN ST
Provider Second Line Business Practice Location Address:
VALLEY REGIONAL PRIMARY CARE PHYSICIANS
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03773-1504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-863-6400
Provider Business Practice Location Address Fax Number:
603-863-7800
Provider Enumeration Date:
09/06/2006

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: 207Q00000X , with the licence number:  034524-23-03 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30343041 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1006587 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2309388YPNH01 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".