Provider Demographics
NPI:1902824329
Name:THOMAS E SIMPSON MDPA
Entity Type:Organization
Organization Name:THOMAS E SIMPSON MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-659-9440
Mailing Address - Street 1:760 HIGHLAND OAKS DR
Mailing Address - Street 2:STE 200
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-7114
Mailing Address - Country:US
Mailing Address - Phone:336-659-9440
Mailing Address - Fax:336-659-9292
Practice Address - Street 1:760 HIGHLAND OAKS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7114
Practice Address - Country:US
Practice Address - Phone:336-659-9440
Practice Address - Fax:336-659-9292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS E SIMPSON MDPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-17
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39466174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8976440Medicaid
NC76440OtherBCBS
NC2318084Medicare ID - Type Unspecified
NC8976440Medicaid