1750855912 NPI number — MS. NICOLE L THOMAS BCBA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750855912 NPI number — MS. NICOLE L THOMAS BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
NICOLE
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750855912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7627 ISLAND CLUB DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46214-4159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-718-1909
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8350 CRAIG ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46250-3593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-578-0410
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-18-33768 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H0032 . This is a "UMR" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: H0032 . This is a "IU HEALTH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: H0032 . This is a "UHC" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 97155 . This is a "MHS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 96151 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 97155 . This is a "CARE SOURCE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 97155 . This is a "AETNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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