Provider Demographics
NPI:1659498772
Name:KATHY J THOMAS, MD PLLC
Entity Type:Organization
Organization Name:KATHY J THOMAS, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-380-5560
Mailing Address - Street 1:179 N BELLAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2065
Mailing Address - Country:US
Mailing Address - Phone:502-380-5560
Mailing Address - Fax:502-491-4110
Practice Address - Street 1:179 N BELLAIRE AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2065
Practice Address - Country:US
Practice Address - Phone:502-380-5560
Practice Address - Fax:502-491-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY=========OtherTAX ID
KY=========OtherTAX ID
KY00180Medicare PIN