Provider Demographics
NPI:1972710010
Name:CHAD L. THOMPSON, DPM, LLC
Entity Type:Organization
Organization Name:CHAD L. THOMPSON, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-812-3636
Mailing Address - Street 1:2730 S VAL VISTA DR
Mailing Address - Street 2:SUITE 175
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1683
Mailing Address - Country:US
Mailing Address - Phone:480-812-3636
Mailing Address - Fax:480-812-3637
Practice Address - Street 1:2730 S VAL VISTA DR
Practice Address - Street 2:SUITE 175
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1683
Practice Address - Country:US
Practice Address - Phone:480-812-3636
Practice Address - Fax:480-812-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0578213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ83482Medicare ID - Type UnspecifiedINDIVIDUAL
AZ6071880001Medicare NSC
AZU96618Medicare UPIN
AZ83480Medicare ID - Type UnspecifiedGROUP NUMBER