Healthcare Provider Details

I. General information

NPI: 1225639503
Provider Name (Legal Business Name): DEBRA KAY THOMAS HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/04/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 CHARLESTOWN RD
NEW ALBANY IN
47150-1978
US

IV. Provider business mailing address

2870 CHARLESTOWN RD
NEW ALBANY IN
47150-1978
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-0235
  • Fax:
Mailing address:
  • Phone: 812-945-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001545A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: