Provider Demographics
NPI:1831258516
Name:THOMPSON HEALTHCARE PROVIDER SERVICES LLC
Entity type:Organization
Organization Name:THOMPSON HEALTHCARE PROVIDER SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILL
Authorized Official - Middle Name:DONN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:830-334-7289
Mailing Address - Street 1:PO BOX 76
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:TX
Mailing Address - Zip Code:78057-0076
Mailing Address - Country:US
Mailing Address - Phone:830-334-7289
Mailing Address - Fax:
Practice Address - Street 1:16444 INTERSTATE HIGHWAY 35 SOUTH
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:TX
Practice Address - Zip Code:78057
Practice Address - Country:US
Practice Address - Phone:830-334-7289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W303Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER