Provider Demographics
NPI:1215102090
Name:ELIZABETH SUE THOMPSON
Entity type:Organization
Organization Name:ELIZABETH SUE THOMPSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-383-2860
Mailing Address - Street 1:229 HARRIS LN
Mailing Address - Street 2:
Mailing Address - City:YANTIS
Mailing Address - State:TX
Mailing Address - Zip Code:75497-9730
Mailing Address - Country:US
Mailing Address - Phone:903-383-2860
Mailing Address - Fax:903-383-7975
Practice Address - Street 1:229 HARRIS LN
Practice Address - Street 2:
Practice Address - City:YANTIS
Practice Address - State:TX
Practice Address - Zip Code:75497-9730
Practice Address - Country:US
Practice Address - Phone:903-383-2860
Practice Address - Fax:903-383-7975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51264227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Single Specialty