Provider Demographics
NPI:1275861890
Name:MICHAEL THOMPSON MD INC
Entity Type:Organization
Organization Name:MICHAEL THOMPSON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-585-1158
Mailing Address - Street 1:PO BOX 1147
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-1147
Mailing Address - Country:US
Mailing Address - Phone:559-585-1158
Mailing Address - Fax:559-585-8116
Practice Address - Street 1:307 MALL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5793
Practice Address - Country:US
Practice Address - Phone:559-585-1158
Practice Address - Fax:559-585-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BT0200636OtherDEA