1093888224 NPI number — MS. MEREDITH LEIGH THOMAS PA-C

Table of content: MS. MEREDITH LEIGH THOMAS PA-C (NPI 1093888224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093888224 NPI number — MS. MEREDITH LEIGH THOMAS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
MEREDITH
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MS.
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:
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:
1093888224
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 S FISKE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32955-4306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 HICKORY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32901-3224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-434-1401
Provider Business Practice Location Address Fax Number:
321-434-1667
Provider Enumeration Date:
11/16/2006

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: 363AM0700X , with the licence number:  232558 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: PA04975 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: PA9115907 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 208057402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208057401 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: D07564 . This is a "MEDICARE RR PALMETTO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TXB149935 . This is a "PROVIDER TRANSACTION ACCESS NUMBER (PTAN)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 327288YV3C . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 891N49 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 273899YPWZ . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: QU188 . This is a "HFPSI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DQ5280 . This is a "MEDICARE RR PALMETTO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: QU189 . This is a "HFMG" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 117865200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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