Provider Demographics
NPI:1043391972
Name:THOMAS HELLERUD
Entity type:Organization
Organization Name:THOMAS HELLERUD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:HELLERUD
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:785-899-7344
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:110 W 6TH ST
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735-0729
Mailing Address - Country:US
Mailing Address - Phone:785-899-7344
Mailing Address - Fax:785-899-5088
Practice Address - Street 1:110 W 6TH ST
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735-0729
Practice Address - Country:US
Practice Address - Phone:785-899-7344
Practice Address - Fax:785-899-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS44102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R75994Medicare UPIN
KS160930Medicare ID - Type Unspecified