1003417411 NPI number — ERIN HALEY THOMAS PA-C

Table of content: ERIN HALEY THOMAS PA-C (NPI 1003417411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003417411 NPI number — ERIN HALEY THOMAS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
ERIN
Provider Middle Name:
HALEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIMS
Provider Other First Name:
ERIN
Provider Other Middle Name:
HALEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003417411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6600 S YALE AVE STE 1400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74136-3331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-247-0125
Provider Business Mailing Address Fax Number:
918-502-8210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6465 S YALE AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74136-7803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-502-1715
Provider Business Practice Location Address Fax Number:
918-502-7180
Provider Enumeration Date:
11/03/2020

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: 363AS0400X , with the licence number:  4490 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200939930A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".