Provider Demographics
NPI:1922071281
Name:THOMPSON, SCOTT WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:WILLIAM
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 1:2016 SUMTER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2100
Mailing Address - Country:US
Mailing Address - Phone:803-744-2700
Mailing Address - Fax:803-744-7979
Practice Address - Street 1:2016 SUMTER ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2100
Practice Address - Country:US
Practice Address - Phone:803-744-2700
Practice Address - Fax:803-744-7979
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22065207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC220656Medicaid
SC204836403OtherTAX ID
SCG903911863Medicare ID - Type Unspecified
SC220656Medicaid