MEDICARE: ELIZABETH THOMAS

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	237600000X	Audiologist-Hearing Aid Fitter	8129	MN
2	231H00000X	Audiologist	8129	MN

General Provider Information

NPI Number	:	1780076828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH THOMAS

Provider Business Mailing Address
First Line	:	7820 TERREY PINE CT STE 110
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55347-1107
Country	:	US
Telephone Number	:	952-594-8358
Fax Number	:	952-479-4639

Provider Business Practice Location Address
First Line	:	7820 TERREY PINE CT
Second Line	:	SUITE 110
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55347-1104
Country	:	US
Telephone Number	:	952-594-8358
Fax Number	:	952-479-4639

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	01/14/2021

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