Provider Demographics
NPI:1124033550
Name:THOMPSON, SAMUEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:T
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-807-1262
Mailing Address - Fax:317-859-4268
Practice Address - Street 1:679 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1049
Practice Address - Country:US
Practice Address - Phone:317-859-7222
Practice Address - Fax:317-859-7220
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041048A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN340012497OtherMEDICARE RAILROAD
IN100194370OtherMEDICAID GROUP NUMBER
IN340012510OtherMEDICARE RAILROAD
IN200288740OtherMEDICAID GROUP NUMBER
IN100343300Medicaid
IN340012524OtherMEDICARE RAILROAD
IN000000091692OtherANTHEM PIN NUMBER
IN1487680518OtherGROUP NPI
IN100194370OtherMEDICAID GROUP NUMBER
IN896480CMedicare PIN
IN318870KMedicare PIN
IN345000CMedicare PIN
INF55807Medicare UPIN
IN100343300Medicaid