Provider Demographics
NPI:1225426075
Name:HICKS, THOMAS (CNA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:HICKS
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 551
Mailing Address - Street 2:502 SOUTH MARKET STREET
Mailing Address - City:SCHAEFFERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17088
Mailing Address - Country:US
Mailing Address - Phone:717-949-2696
Mailing Address - Fax:
Practice Address - Street 1:502 SOUTH MARKET STREET
Practice Address - Street 2:
Practice Address - City:SCHAEFFERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17088
Practice Address - Country:US
Practice Address - Phone:717-949-2696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10048190171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor