1558377341 NPI number — THORNE MEDICAL SERVICES, LTD

Table of content: (NPI 1558377341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558377341 NPI number — THORNE MEDICAL SERVICES, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THORNE MEDICAL SERVICES, LTD
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:
PRIMARY CARE CENTRE
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:
1558377341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 766
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24348-0766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-773-2218
Provider Business Mailing Address Fax Number:
276-773-2815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 E. MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24348-0766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-773-2218
Provider Business Practice Location Address Fax Number:
276-773-2815
Provider Enumeration Date:
07/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THORNE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
FRANKLIN
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
273-773-2218

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  0102032808 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 890643C , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 217072 . This is a "ANTHEM BC/BS VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".