Provider Demographics
NPI:1811935927
Name:THOMPSON, ELAINE ALLEN (MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:ALLEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8110 N BROTHER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2760
Mailing Address - Country:US
Mailing Address - Phone:901-255-5221
Mailing Address - Fax:901-373-4511
Practice Address - Street 1:7900 AIRWAYS BLVD. BLDG C
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4114
Practice Address - Country:US
Practice Address - Phone:662-349-5554
Practice Address - Fax:662-349-5570
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41322207V00000X
MS19406207V00000X
AL25623207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00304573Medicaid
P00391231OtherRAILROAD MEDICARE
TN3810336Medicaid
TN4134185OtherBCBS
MS00304573Medicaid
MS160000704Medicare PIN
P00391231OtherRAILROAD MEDICARE