1295785822 NPI number — KEITH D THOMAS MD

Table of content: KEITH D THOMAS MD (NPI 1295785822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295785822 NPI number — KEITH D THOMAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
KEITH
Provider Middle Name:
D
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:
1295785822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
815 E PARRISH AVE
Provider Second Line Business Mailing Address:
STE 460
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42303-3222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-684-5005
Provider Business Mailing Address Fax Number:
270-926-4432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 E PARRISH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-3258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-684-5005
Provider Business Practice Location Address Fax Number:
270-926-4432
Provider Enumeration Date:
05/12/2006

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: 207L00000X , with the licence number:  01044112A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X , with the licence number: 01044112A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000067774 . This is a "BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000683152 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0360915761 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050040838 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200047560 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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