1548277353 NPI number — DR. DIRK R THOMPSON MD

Table of content: DR. DIRK R THOMPSON MD (NPI 1548277353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548277353 NPI number — DR. DIRK R THOMPSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
DIRK
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548277353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 616788
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32861-6788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-533-6837
Provider Business Mailing Address Fax Number:
407-770-0661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19401 E 39TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64057-2308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-490-4277
Provider Business Practice Location Address Fax Number:
855-446-7160
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  47119 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 2019003502 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MA8204004 . This is a "MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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