Provider Demographics
NPI:1588656078
Name:THOMPSON, OSCAR W III (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:W
Last Name:THOMPSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-3510
Mailing Address - Country:US
Mailing Address - Phone:606-432-0079
Mailing Address - Fax:606-432-1088
Practice Address - Street 1:387 TOWN MOUNTAIN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1640
Practice Address - Country:US
Practice Address - Phone:606-432-0079
Practice Address - Fax:606-432-1088
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22466174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64224660Medicaid
000000048600OtherBC/BS
1328779OtherUMWA
1411901Medicare ID - Type Unspecified
C63813Medicare UPIN