Provider Demographics
NPI:1124404546
Name:JEAN-ALFRED THOMAS INC
Entity Type:Organization
Organization Name:JEAN-ALFRED THOMAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:314-644-4555
Mailing Address - Street 1:1031 BELLEVUE AVE # B
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1818
Mailing Address - Country:US
Mailing Address - Phone:314-644-4555
Mailing Address - Fax:314-644-4255
Practice Address - Street 1:1031 BELLEVUE AVE # B
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1818
Practice Address - Country:US
Practice Address - Phone:314-644-4555
Practice Address - Fax:314-644-4255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8402207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000001490Medicare UPIN