Provider Demographics
NPI:1528378353
Name:CHARLES D THOMPSON MD PLLC
Entity Type:Organization
Organization Name:CHARLES D THOMPSON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-454-1722
Mailing Address - Street 1:3900 JOE RAMSEY BLVD E
Mailing Address - Street 2:SUITE E
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7770
Mailing Address - Country:US
Mailing Address - Phone:903-454-1722
Mailing Address - Fax:903-454-1750
Practice Address - Street 1:3900 JOE RAMSEY BLVD E
Practice Address - Street 2:SUITE E
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7770
Practice Address - Country:US
Practice Address - Phone:903-454-1722
Practice Address - Fax:903-454-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6650207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216349501Medicaid
TXTXB113282Medicare UPIN