Provider Demographics
NPI:1801874243
Name:THEBY, JANET E (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:E
Last Name:THEBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 W EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-5888
Mailing Address - Country:US
Mailing Address - Phone:573-635-0233
Mailing Address - Fax:573-635-7436
Practice Address - Street 1:2707 W EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5888
Practice Address - Country:US
Practice Address - Phone:573-635-0233
Practice Address - Fax:573-635-7436
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1196653OtherFIRST HEALTH
MO206878258Medicaid
MO508069101Medicaid
241056OtherHEALTHLINK
B08074OtherMERCY
CH5818OtherRR MEDICARE
080193832OtherRR MEDICARE
44 0546366OtherUNITED HEALTHCARE
MO501607808Medicaid
25147OtherBLUE CROSS BLUE SHIELD
CD6730OtherRR MEDICARE
P00099221OtherRR MEDICARE
MO206878233Medicaid
MO206878241Medicaid
4640661OtherCIGNA
MO500383609Medicaid
CK7821OtherRR MEDICARE
080187712OtherRR MEDICARE
012012090Medicare ID - Type Unspecified
MO501607808Medicaid