Provider Demographics
NPI:1710176235
Name:THOMPSON FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:THOMPSON FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CYRUS
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:812-743-5113
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:MONROE CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47557-0006
Mailing Address - Country:US
Mailing Address - Phone:812-743-5113
Mailing Address - Fax:
Practice Address - Street 1:1201 MAIN ST.
Practice Address - Street 2:
Practice Address - City:MONROE CITY
Practice Address - State:IN
Practice Address - Zip Code:47557-0006
Practice Address - Country:US
Practice Address - Phone:812-743-5113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232620Medicare PIN