Provider Demographics
NPI:1043590722
Name:ALICIA THOMPSON MD PLLC
Entity Type:Organization
Organization Name:ALICIA THOMPSON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-657-4537
Mailing Address - Street 1:15005 SALEM CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2455
Mailing Address - Country:US
Mailing Address - Phone:405-657-4537
Mailing Address - Fax:405-347-7617
Practice Address - Street 1:15005 SALEM CREEK RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2455
Practice Address - Country:US
Practice Address - Phone:405-657-4537
Practice Address - Fax:405-347-7617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK257762084P0804X
261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO091050022Medicaid
OK25776OtherLISCENSE
MO108326OtherMEDICAL LISCENSE
OK100125890AMedicaid