Provider Demographics
NPI:1760423529
Name:AMANDA THOMAS, LLC
Entity Type:Organization
Organization Name:AMANDA THOMAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STAITI
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:603-595-9447
Mailing Address - Street 1:30 DANIEL WEBSTER HWY, STE 1
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054
Mailing Address - Country:US
Mailing Address - Phone:603-595-9447
Mailing Address - Fax:603-595-9445
Practice Address - Street 1:30 DANIEL WEBSTER HWY, STE 1
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054
Practice Address - Country:US
Practice Address - Phone:603-595-9447
Practice Address - Fax:603-595-9445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH5323170001Medicare NSC