Healthcare Provider Details

I. General information

NPI: 1265244438
Provider Name (Legal Business Name): THOMAS JAMES VERMILLION
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7408 CEDAR ST APT 211
OMAHA NE
68124-2321
US

IV. Provider business mailing address

7408 CEDAR ST APT 211
OMAHA NE
68124-2321
US

V. Phone/Fax

Practice location:
  • Phone: 402-779-6895
  • Fax:
Mailing address:
  • Phone: 402-779-6895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number163WH0200X
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: