Provider Demographics
NPI:1689966632
Name:GROTHE, THOMAS JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:GROTHE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984300 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-4300
Mailing Address - Country:US
Mailing Address - Phone:402-559-9495
Mailing Address - Fax:402-559-7996
Practice Address - Street 1:984300 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-4300
Practice Address - Country:US
Practice Address - Phone:402-559-9495
Practice Address - Fax:402-559-7996
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE344363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant