Provider Demographics
NPI:1023200953
Name:THOMAS H THOMPSON MD PC
Entity Type:Organization
Organization Name:THOMAS H THOMPSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-677-1256
Mailing Address - Street 1:2508 NW MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-5510
Mailing Address - Country:US
Mailing Address - Phone:541-677-1256
Mailing Address - Fax:541-673-1160
Practice Address - Street 1:2508 NW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-5510
Practice Address - Country:US
Practice Address - Phone:541-677-1256
Practice Address - Fax:541-673-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13952207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200046321OtherRAILROAD MEDICARE
OR221523Medicaid
OR4773340001Medicare NSC
ORR114569Medicare PIN
OR200046321OtherRAILROAD MEDICARE