Provider Demographics
NPI:1336314939
Name:THOMAS FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:THOMAS FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIOTER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-367-2578
Mailing Address - Street 1:1400 N 2ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-1203
Mailing Address - Country:US
Mailing Address - Phone:913-367-2578
Mailing Address - Fax:913-367-2589
Practice Address - Street 1:1400 N 2ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-1203
Practice Address - Country:US
Practice Address - Phone:913-367-2578
Practice Address - Fax:913-367-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0424755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
APPLYINGMedicare PIN