Basic Information
Provider Information
NPI: 1073039186
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HELM
FirstName: THOMAS
MiddleName: LANDON
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 13677 W MCDOWELL RD
Address2:  
City: GOODYEAR
State: AZ
PostalCode: 853952635
CountryCode: US
TelephoneNumber: 6238566641
FaxNumber:  
Practice Location
Address1: 13677 W MCDOWELL RD
Address2:  
City: GOODYEAR
State: AZ
PostalCode: 853952635
CountryCode: US
TelephoneNumber: 6238821500
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/21/2017
LastUpdateDate: 09/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X AZY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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