Provider Demographics
NPI:1609819994
Name:THOMAS, JASON C (CRNA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:C
Last Name:THOMAS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9031
Mailing Address - Country:US
Mailing Address - Phone:740-779-7540
Mailing Address - Fax:740-779-7867
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5238
Practice Address - Fax:740-441-8058
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV54566367500000X
OHNA05455367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000198573OtherANTHEM BCBS
WV5710266000Medicaid
001714119OtherMOUNTAIN STATE BCBS
OH2239769Medicaid
OH000000204810OtherOH MEDICAID UNISON
OH2239769OtherMOLINA MEDICAID #
OH430055401OtherRR MEDICARE
OH000000204810OtherOH MEDICAID UNISON
F05712Medicare UPIN