Provider Demographics
NPI:1013955368
Name:THOMPSON, JAMES C (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 SE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-8137
Mailing Address - Country:US
Mailing Address - Phone:954-943-9491
Mailing Address - Fax:954-943-9492
Practice Address - Street 1:731 SE 6TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-8137
Practice Address - Country:US
Practice Address - Phone:954-943-9491
Practice Address - Fax:954-943-9492
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2127012367500000X
KY033120367500000X
KY1044987163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200867430Medicaid
FL304408400Medicaid
OH0762983Medicaid
9477029OtherPHCS
KY74054115Medicaid
G1440OtherBCBS
000000514343OtherANTHEM
IN200867430Medicaid
000000514343OtherANTHEM
FL304408400Medicaid
P00416437Medicare PIN
000000514343OtherANTHEM