Provider Demographics
NPI:1114372125
Name:THOMPSON FAMILY PRACTICE
Entity Type:Organization
Organization Name:THOMPSON FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:VALISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-474-7445
Mailing Address - Street 1:2222 S 16TH ST STE 435
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3793
Mailing Address - Country:US
Mailing Address - Phone:402-474-7445
Mailing Address - Fax:402-474-4792
Practice Address - Street 1:2222 S 16TH ST
Practice Address - Street 2:SUITE 435
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-6796
Practice Address - Country:US
Practice Address - Phone:402-474-7445
Practice Address - Fax:402-474-4792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty