Provider Demographics
NPI:1720011463
Name:BARRY V. THOMPSON, M.D. P.A.
Entity Type:Organization
Organization Name:BARRY V. THOMPSON, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-364-5746
Mailing Address - Street 1:103 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-2915
Mailing Address - Country:US
Mailing Address - Phone:870-364-5746
Mailing Address - Fax:870-364-5745
Practice Address - Street 1:103 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-2915
Practice Address - Country:US
Practice Address - Phone:870-364-5746
Practice Address - Fax:870-364-5745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR109790001Medicaid
ARD75028Medicare UPIN
AR55284Medicare ID - Type Unspecified