Provider Demographics
NPI:1831113752
Name:THOMPSON, ARLISS N (MD)
Entity Type:Individual
Prefix:
First Name:ARLISS
Middle Name:N
Last Name:THOMPSON
Suffix:
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 20190
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7004
Mailing Address - Country:US
Mailing Address - Phone:307-635-5393
Mailing Address - Fax:307-635-2199
Practice Address - Street 1:4500 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8148
Practice Address - Country:US
Practice Address - Phone:307-635-5393
Practice Address - Fax:307-635-2199
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6917A207PE0004X
SD3438207PE0004X, 207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY118742200Medicaid
SD6002984Medicaid
SDP00056204SOtherRAILROAD ID
SD4993306OtherSD BCBS
WY312263OtherBLUE SHIELD
WY82601D032OtherWPS TRIWEST
WY82601D032OtherWPS TRIWEST
WYE78832Medicare UPIN
SD101624Medicare PIN