Provider Demographics
NPI:1134177579
Name:THOMPSON & GLYMPH, PA
Entity type:Organization
Organization Name:THOMPSON & GLYMPH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-569-0000
Mailing Address - Street 1:4800 NE STALLINGS DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1249
Mailing Address - Country:US
Mailing Address - Phone:936-569-0000
Mailing Address - Fax:936-560-4932
Practice Address - Street 1:4800 NE STALLINGS DR
Practice Address - Street 2:SUITE 106
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1249
Practice Address - Country:US
Practice Address - Phone:936-569-0000
Practice Address - Fax:936-560-4932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W143Medicare ID - Type Unspecified