Provider Demographics
NPI:1164587119
Name:THOMPSON, KEVIN H (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:H
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-0886
Mailing Address - Country:US
Mailing Address - Phone:503-561-7160
Mailing Address - Fax:503-561-7180
Practice Address - Street 1:610 HAWTHORNE AVE SE STE 110
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-814-4440
Practice Address - Fax:503-814-4444
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO151094207RC0000X, 207UN0901X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00890306OtherRAILROAD MEDICARE
OR500622719Medicaid
R159997Medicare PIN
OR500622719Medicaid