Provider Demographics
NPI:1871724807
Name:THOMAS, LUCY C (PA-C)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:C
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-1402
Mailing Address - Country:US
Mailing Address - Phone:915-212-1384
Mailing Address - Fax:915-212-0026
Practice Address - Street 1:300 N CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-1402
Practice Address - Country:US
Practice Address - Phone:915-212-1384
Practice Address - Fax:915-212-0026
Is Sole Proprietor?:No
Enumeration Date:2009-08-08
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06302363A00000X
NVPA1240363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1871724087Medicaid
NVP00932142OtherRAILROAD MEDICARE
NVEK622ZMedicare PIN