Provider Demographics
NPI:1689874307
Name:M. ANGELA THOMAS, MD, PC
Entity Type:Organization
Organization Name:M. ANGELA THOMAS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-457-7463
Mailing Address - Street 1:2510 WIGWAM PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7114
Mailing Address - Country:US
Mailing Address - Phone:702-457-7463
Mailing Address - Fax:702-878-7463
Practice Address - Street 1:2510 WIGWAM PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7114
Practice Address - Country:US
Practice Address - Phone:702-457-7463
Practice Address - Fax:702-878-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11173208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH16416Medicare UPIN