Provider Demographics
NPI:1053369934
Name:NICHOLS, THOMAS M (CRNA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 661495
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-1495
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:4800 48TH ST
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3666
Practice Address - Country:US
Practice Address - Phone:334-756-1848
Practice Address - Fax:334-756-1854
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-059468367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA043495579AMedicaid
AL1053369934OtherTRICARE
AL051517975Medicaid
ALP00093299OtherRAILROAD MEDICARE
AL51517975OtherBCBSAL PROVIDER #
AL051517975Medicare PIN
R90040Medicare UPIN