Provider Demographics
NPI:1184688939
Name:VINTON, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:VINTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12728 AUGUSTA AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3702
Mailing Address - Country:US
Mailing Address - Phone:402-330-1410
Mailing Address - Fax:402-330-4294
Practice Address - Street 1:12728 AUGUSTA AVE FL 2
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3702
Practice Address - Country:US
Practice Address - Phone:402-330-1410
Practice Address - Fax:402-330-4294
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE15977OtherSTATE LIC
E48036Medicare UPIN
NE15977OtherSTATE LIC
NE280776Medicare PIN
A151729AMedicare ID - Type Unspecified