Provider Demographics
NPI:1235752429
Name:THOMPSON, TAEZER REEVE
Entity Type:Individual
Prefix:MR
First Name:TAEZER
Middle Name:REEVE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 N MCCART ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-2426
Mailing Address - Country:US
Mailing Address - Phone:254-434-8998
Mailing Address - Fax:
Practice Address - Street 1:970 N MCCART ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-2426
Practice Address - Country:US
Practice Address - Phone:254-434-8998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)