Provider Demographics
NPI:1487834313
Name:JOYCE M. THOMPSON DPM
Entity Type:Organization
Organization Name:JOYCE M. THOMPSON DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-378-4816
Mailing Address - Street 1:640 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-1479
Mailing Address - Country:US
Mailing Address - Phone:937-378-4816
Mailing Address - Fax:937-378-4708
Practice Address - Street 1:640 E STATE ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-1479
Practice Address - Country:US
Practice Address - Phone:937-378-4816
Practice Address - Fax:937-378-4708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002530213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1051770001Medicare NSC