MEDICARE: SUEANN THOMAS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71001592A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	144670	OTHER	IN	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1790837789	OTHER	IN	GROUP NPI NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000990887	OTHER	IN	ANTHEM PIN

General Provider Information

NPI Number	:	1417959917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUEANN THOMAS NP

Provider Business Mailing Address
First Line	:	2896 BLUEBELL CT W
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-9399
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2118 25TH ST STE C
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3240
Country	:	US
Telephone Number	:	812-372-8426
Fax Number	:	812-378-7777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	09/06/2024

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Directions to “ SUEANN THOMAS NP” Practice Location

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