Provider Demographics
NPI:1487822789
Name:MARGIE A. THOMAS
Entity Type:Organization
Organization Name:MARGIE A. THOMAS
Other - Org Name:MARGIE A. THOMAS
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:567-201-0424
Mailing Address - Street 1:1386 VILLAGE WAY
Mailing Address - Street 2:#508
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420
Mailing Address - Country:US
Mailing Address - Phone:567-201-0424
Mailing Address - Fax:419-334-5881
Practice Address - Street 1:1386 VILLAGE WAY
Practice Address - Street 2:APT 508
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3241
Practice Address - Country:US
Practice Address - Phone:440-320-6496
Practice Address - Fax:419-334-5881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARGIE A. THOMAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-20
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-086542313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility