MEDICARE: JANET E THEBY MD

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	207Q00000X	Family Medicine Physician	105073	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
6	CH5818	OTHER	RR MEDICARE
7	080193832	OTHER	RR MEDICARE
11	CD6730	OTHER	RR MEDICARE
12	P00099221	OTHER	RR MEDICARE
17	CK7821	OTHER	RR MEDICARE
18	080187712	OTHER	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1196653	OTHER	FIRST HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	241056	OTHER	HEALTHLINK
5	B08074	OTHER	MERCY
8	44 0546366	OTHER	UNITED HEALTHCARE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	25147	OTHER	BLUE CROSS BLUE SHIELD
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	4640661	OTHER	CIGNA
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801874243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET E THEBY MD

Provider Business Mailing Address
First Line	:	2707 W EDGEWOOD DR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-5888
Country	:	US
Telephone Number	:	573-635-0233
Fax Number	:	573-635-7436

Provider Business Practice Location Address
First Line	:	2707 W EDGEWOOD DR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-5888
Country	:	US
Telephone Number	:	573-635-0233
Fax Number	:	573-635-7436

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	09/24/2013

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Directions to “ JANET E THEBY MD” Practice Location

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