Healthcare Provider Details

I. General information

NPI: 1720651847
Provider Name (Legal Business Name): MR. ELMER R THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14723 W OAKS PLAZA DR APT 433
HOUSTON TX
77082-3980
US

IV. Provider business mailing address

14723 W OAKS PLAZA DR APT 433
HOUSTON TX
77082-3980
US

V. Phone/Fax

Practice location:
  • Phone: 601-382-6620
  • Fax:
Mailing address:
  • Phone: 601-382-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: