Provider Demographics
NPI:1922496116
Name:THOMAS, MARVA
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
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 2288
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2288
Mailing Address - Country:US
Mailing Address - Phone:864-585-5433
Mailing Address - Fax:864-591-4053
Practice Address - Street 1:1330 BOILING SPRINGS RD
Practice Address - Street 2:SUITE 2500
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4201
Practice Address - Country:US
Practice Address - Phone:864-585-5433
Practice Address - Fax:864-591-4053
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19219363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01617602OtherRAILROAD MEDICARE
SCP0L505947OtherRAILROAD MEDICARE
SCNP3064Medicaid
SCSC53796067Medicare PIN
SCNP3064Medicaid