1871535187 NPI number — THOMPSON ORTHOPEDIC CLINIC, PA

Table of content: (NPI 1871535187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871535187 NPI number — THOMPSON ORTHOPEDIC CLINIC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMPSON ORTHOPEDIC CLINIC, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1871535187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 OAK DR S
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
LAKE JACKSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77566-5676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-297-3004
Provider Business Mailing Address Fax Number:
979-299-1301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 OAK DR S
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LAKE JACKSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77566-5676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-297-3004
Provider Business Practice Location Address Fax Number:
979-299-1301
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
SANFORD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
979-297-3004

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  D7333 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DB8385 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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