Provider Demographics
NPI:1831110295
Name:THOMPSON, CHRISTOPHER T (CRNA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:T
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 1:4135 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:2589 BOYCE PLAZA RD
Practice Address - Street 2:
Practice Address - City:UPPER ST CLAIR
Practice Address - State:PA
Practice Address - Zip Code:15241-4907
Practice Address - Country:US
Practice Address - Phone:412-838-0400
Practice Address - Fax:412-281-1898
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN504732L367500000X
OHRN257653367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2560429Medicaid
OH8235302OtherMEDICARE
OH8235302OtherMEDICARE