Provider Demographics
NPI:1568505535
Name:THOMAS, MARCIA L
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3509
Mailing Address - Country:US
Mailing Address - Phone:713-723-2400
Mailing Address - Fax:713-723-2404
Practice Address - Street 1:421 E LAUREL AVE
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3509
Practice Address - Country:US
Practice Address - Phone:713-723-2400
Practice Address - Fax:713-723-2404
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1330655Medicaid
LA1330655Medicaid