Provider Demographics
NPI:1437865532
Name:THOMPSON PEDORTHICS LLC
Entity Type:Organization
Organization Name:THOMPSON PEDORTHICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DEMON
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:912-492-1824
Mailing Address - Street 1:200 W HARRISON ST STE B
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-3331
Mailing Address - Country:US
Mailing Address - Phone:912-492-1824
Mailing Address - Fax:
Practice Address - Street 1:200 W HARRISON ST STE B
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-3331
Practice Address - Country:US
Practice Address - Phone:912-492-1824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty