=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932220365
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. PATRICIA THOMAS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 ROCK POINT
-----------------------------------------------------
City | DEL VALLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-247-3475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1205
-----------------------------------------------------
City | DEL VALLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78617-1205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-247-3475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number | 0004985
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------