Provider Demographics
NPI:1982807848
Name:JENNIFER J. THOMAS MDPC
Entity Type:Organization
Organization Name:JENNIFER J. THOMAS MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-687-1720
Mailing Address - Street 1:PO BOX 7150
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-7150
Mailing Address - Country:US
Mailing Address - Phone:307-685-0222
Mailing Address - Fax:
Practice Address - Street 1:1204 W 4TH AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-2607
Practice Address - Country:US
Practice Address - Phone:307-685-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5441A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY308396Medicare ID - Type Unspecified