Provider Demographics
NPI:1770188948
Name:THOMAS, ADRIAN
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:OBERON
Mailing Address - State:ND
Mailing Address - Zip Code:58357-0038
Mailing Address - Country:US
Mailing Address - Phone:701-381-9694
Mailing Address - Fax:
Practice Address - Street 1:7114 CROW HILL ROAD
Practice Address - Street 2:
Practice Address - City:FT TOTTEN
Practice Address - State:ND
Practice Address - Zip Code:58335-0038
Practice Address - Country:US
Practice Address - Phone:701-381-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant