Provider Demographics
NPI:1396833505
Name:CLOVEN, THOMAS W (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:CLOVEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-0946
Mailing Address - Country:US
Mailing Address - Phone:620-431-2500
Mailing Address - Fax:620-431-4418
Practice Address - Street 1:505 S. PLUMMER AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1950
Practice Address - Country:US
Practice Address - Phone:620-431-4418
Practice Address - Fax:620-431-4418
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00347392OtherRR MC
KS100385740BMedicaid
426870Medicare PIN
P18156Medicare UPIN