Provider Demographics
NPI:1558672204
Name:MARTHA THOMAS MD PA
Entity Type:Organization
Organization Name:MARTHA THOMAS MD PA
Other - Org Name:THE CENTER FOR PEDIATRIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-268-5437
Mailing Address - Street 1:214 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1616
Mailing Address - Country:US
Mailing Address - Phone:414-247-9005
Mailing Address - Fax:414-247-9004
Practice Address - Street 1:403 S POPLAR ST
Practice Address - Street 2:SUITE F
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6017
Practice Address - Country:US
Practice Address - Phone:501-268-5437
Practice Address - Fax:501-268-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC2771208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARMC2771OtherMEDICAL CORPORATION CERTIFICATE
AR5G580Medicare PIN