Provider Demographics
NPI:1003834748
Name:THOMAS, J ROSS (CRNA)
Entity Type:Individual
Prefix:MR
First Name:J
Middle Name:ROSS
Last Name:THOMAS
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8054
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-6973
Mailing Address - Fax:314-362-1185
Practice Address - Street 1:7 INDEPENDENCE PT STE 300
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4569
Practice Address - Country:US
Practice Address - Phone:864-522-3700
Practice Address - Fax:864-522-3705
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO101302367500000X
SC22401367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO912717006Medicaid
ILENROLLEDMedicaid
SCAN2851Medicaid
AR196556001Medicaid
MO064060042Medicare PIN