Thiele, Mark A
Thiele, Mark A is an individual health care provider with primary practice located at 1223 Willow Creek Rd , Prescott AZ 86301-1427. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Thiele, Mark A can be contacted via phone (928) 777-9950.Contact Information
Primary practice address
1223 Willow Creek Rd
Prescott AZ 86301-1427
Phone: (928) 777-9950
Fax: (928) 777-9975
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 4659 | Arizona |
Profile Details
| NPI number | 1992708523 |
|---|---|
| LBN Legal business name | Thiele, Mark A |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 27th, 2005 |
| Last updated | Mar 29th, 2017 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1992708523 | NPPES |
| Florida | MEDICAID | 291957500 | |
| Florida | MEDICAID | 782816 |
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