Provider Demographics
NPI:1861470478
Name:THOMPSON, KEITH S (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:S
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 2153 DEPT 40339
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-9387
Mailing Address - Country:US
Mailing Address - Phone:706-271-0100
Mailing Address - Fax:706-270-0487
Practice Address - Street 1:4800 W 25TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3734
Practice Address - Country:US
Practice Address - Phone:970-330-6400
Practice Address - Fax:706-270-0487
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00944807OtherMEDICARE RAILROAD CARRIER PTAN
CO01325968Medicaid
COCOA102150Medicare PIN
COP00944807OtherMEDICARE RAILROAD CARRIER PTAN
CO01325968Medicaid
COC20848Medicare PIN