Provider Demographics
NPI:1457731499
Name:THIN RYNO, PLLC
Entity Type:Organization
Organization Name:THIN RYNO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAJORITY MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:COLEY
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:817-253-7605
Mailing Address - Street 1:5036 GADSDEN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5036 GADSDEN AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5919
Practice Address - Country:US
Practice Address - Phone:817-253-7605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP19372420OtherARIZONA CORPORATION COMMISSION