Provider Demographics
NPI:1578725636
Name:THOMAS FAMILY CARE LLC
Entity Type:Organization
Organization Name:THOMAS FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:G
Authorized Official - Last Name:AUNKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-224-7755
Mailing Address - Street 1:1928 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-5903
Mailing Address - Country:US
Mailing Address - Phone:405-224-7755
Mailing Address - Fax:405-224-7748
Practice Address - Street 1:1928 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-5903
Practice Address - Country:US
Practice Address - Phone:405-224-7755
Practice Address - Fax:405-224-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17600207R00000X
OKPA 467363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200131240AMedicaid