Provider Demographics
NPI:1831808500
Name:SIMMONS, THOMAS J III
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:SIMMONS
Suffix:III
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 1:7940 FRONT BEACH RD # 2018
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-4817
Mailing Address - Country:US
Mailing Address - Phone:850-703-7928
Mailing Address - Fax:
Practice Address - Street 1:1308 BRICKYARD RD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-2437
Practice Address - Country:US
Practice Address - Phone:850-703-7928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS552830781650343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)