Provider Demographics
NPI:1366773798
Name:THOMAS NEUROLOGY CLINIC PA
Entity type:Organization
Organization Name:THOMAS NEUROLOGY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-315-1117
Mailing Address - Street 1:1000 HIGHWAY 35 N
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-2351
Mailing Address - Country:US
Mailing Address - Phone:501-315-1117
Mailing Address - Fax:501-315-2408
Practice Address - Street 1:1000 HIGHWAY 35 N
Practice Address - Street 2:SUITE 5
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-2351
Practice Address - Country:US
Practice Address - Phone:501-315-1117
Practice Address - Fax:501-315-2408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2010261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124224001Medicaid
5G428OtherPTAN
7115035OtherAETNA
18328000000OtherQUALCHOICE
ARDP8413OtherRAILROAD MEDICARE
AR124224001Medicaid