1912945221 NPI number — MS. BERNICE DELORES THOMAS SOCIAL WORKER

Table of content: MS. BERNICE DELORES THOMAS SOCIAL WORKER (NPI 1912945221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912945221 NPI number — MS. BERNICE DELORES THOMAS SOCIAL WORKER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
BERNICE
Provider Middle Name:
DELORES
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
SOCIAL WORKER
Provider Gender Code:
F

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:
1912945221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1933 N 73RD TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66112-2315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-682-2000
Provider Business Mailing Address Fax Number:
913-758-4219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DD EISENHOWER VETERANS AFFAIRS MEDICAL CENTER
Provider Second Line Business Practice Location Address:
4101 S. 4TH ST. TRAFFICWAY
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
66048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-682-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2006

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: 1041C0700X , with the licence number:  LMSW 577 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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