Provider Demographics
NPI:1023376183
Name:JERRY A.THOMAS M.D., L.L.C.
Entity type:Organization
Organization Name:JERRY A.THOMAS M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:DOKKA
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-795-4147
Mailing Address - Street 1:51704 HIGHWAY 438
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438
Mailing Address - Country:US
Mailing Address - Phone:985-848-9955
Mailing Address - Fax:985-848-9964
Practice Address - Street 1:51704 HIGHWAY 438
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438
Practice Address - Country:US
Practice Address - Phone:985-848-9955
Practice Address - Fax:985-848-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.015223261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1321044Medicaid
LA5DX93OtherMEDICARE PTAN
LA5DX93OtherMEDICARE PTAN