1245424555 NPI number — THELMA DIANE THOMAS CNM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245424555 NPI number — THELMA DIANE THOMAS CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
THELMA
Provider Middle Name:
DIANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCLAMB
Provider Other First Name:
THELMA
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245424555
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1ST MEDICAL GROUP
Provider Second Line Business Mailing Address:
77 NEALY AVENUE
Provider Business Mailing Address City Name:
LANGLEY AFB
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23665-2023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-764-1043
Provider Business Mailing Address Fax Number:
757-764-6843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1ST MEDICAL GROUP
Provider Second Line Business Practice Location Address:
77 NEALY AVENUE
Provider Business Practice Location Address City Name:
LANGLEY AFB
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23665-2023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-764-1043
Provider Business Practice Location Address Fax Number:
757-764-6843
Provider Enumeration Date:
08/29/2007

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: 367A00000X , with the licence number:  0024053431 , 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)