1104807221 NPI number — VILMOS A THOMAZY MD

Table of content: VILMOS A THOMAZY MD (NPI 1104807221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104807221 NPI number — VILMOS A THOMAZY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAZY
Provider First Name:
VILMOS
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1104807221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 164106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78716-4106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-901-1206
Provider Business Mailing Address Fax Number:
512-901-1299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12221 N MOPAC EXPRESSWAY
Provider Second Line Business Practice Location Address:
NAMC DEPARTMENT OF PATHOLOGY
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-901-1206
Provider Business Practice Location Address Fax Number:
512-901-1299
Provider Enumeration Date:
11/07/2005

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: 207ZP0102X , with the licence number:  L6670 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZP0102X , with the licence number: 4301077314 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 151922505 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 151922507 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8K6433 . This is a "BCBSTX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 151922503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 151922504 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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