Provider Demographics
NPI:1275819575
Name:THOMPSON, MELVIN D
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:D
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 1:3634 SENECA HIGHLAND
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0494
Mailing Address - Country:US
Mailing Address - Phone:702-503-8843
Mailing Address - Fax:
Practice Address - Street 1:3634 SENECA HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0494
Practice Address - Country:US
Practice Address - Phone:702-503-8843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2018-11-02
Deactivation Date:2018-02-12
Deactivation Code:
Reactivation Date:2018-02-27
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV45-3689144Medicaid