Healthcare Provider Details

I. General information

NPI: 1962086496
Provider Name (Legal Business Name): THOMAS CARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 E SUNSHINE ST
SPRINGFIELD MO
65804-1815
US

IV. Provider business mailing address

2040 E SUNSHINE ST
SPRINGFIELD MO
65804-1815
US

V. Phone/Fax

Practice location:
  • Phone: 417-275-8900
  • Fax: 417-270-8012
Mailing address:
  • Phone: 417-275-8900
  • Fax: 417-270-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALICIA R THOMAS
Title or Position: CLINIC OWNER
Credential: FNP-BC
Phone: 417-275-8900