Healthcare Provider Details

I. General information

NPI: 1427962208
Provider Name (Legal Business Name): MICHAEL THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13621 V AVE
CEDAR FALLS IA
50613-8243
US

IV. Provider business mailing address

13621 V AVE
CEDAR FALLS IA
50613-8243
US

V. Phone/Fax

Practice location:
  • Phone: 319-404-2126
  • Fax:
Mailing address:
  • Phone: 319-404-2126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License NumberAEMT4000184
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number168873
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: