MEDICARE: THOMAS NEUROLOGY CLINIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	E2010	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	DP8413	OTHER	AR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5G428	OTHER	PTAN
3	7115035	OTHER	AETNA
4	18328000000	OTHER	QUALCHOICE

General Provider Information

NPI Number	:	1366773798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS NEUROLOGY CLINIC PA

Provider Business Mailing Address
First Line	:	1000 HIGHWAY 35 N
Second Line	:	SUITE 5
City	:	BENTON
State	:	AR
Zip	:	72019-2351
Country	:	US
Telephone Number	:	501-315-1117
Fax Number	:	501-315-2408

Provider Business Practice Location Address
First Line	:	1000 HIGHWAY 35 N
Second Line	:	SUITE 5
City	:	BENTON
State	:	AR
Zip	:	72019-2351
Country	:	US
Telephone Number	:	501-315-1117
Fax Number	:	501-315-2408

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. JAMES EDWARD THOMAS
Credential	:	MD
Telephone Number	:	501-315-1117

Provider Enumeration Date	:	01/25/2010
Last Update Date	:	01/31/2011

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Directions to “THOMAS NEUROLOGY CLINIC PA ” Practice Location

Language	Start Address	Practice Location

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