Healthcare Provider Details

I. General information

NPI: 1275937740
Provider Name (Legal Business Name): THOMAS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12409 W INDIAN SCHOOL RD 210
AVONDALE AZ
85392-9502
US

IV. Provider business mailing address

12409 W INDIAN SCHOOL RD 210
AVONDALE AZ
85392-9502
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-9920
  • Fax:
Mailing address:
  • Phone: 623-935-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY A MCCGUIRE
Title or Position: BILLING MANAGER
Credential:
Phone: 623-760-4030