1487123840 NPI number — MARLEE ANN THOMAS

Table of content: MARLEE ANN THOMAS (NPI 1487123840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487123840 NPI number — MARLEE ANN THOMAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
MARLEE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1487123840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 614
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPKINSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42241-0614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-886-2205
Provider Business Mailing Address Fax Number:
270-886-0392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
735 NORTH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42240-2620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-886-5163
Provider Business Practice Location Address Fax Number:
270-886-5178
Provider Enumeration Date:
11/15/2018

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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