1619237955 NPI number — ANDREW LEE THOMPSON DMD PC & ASSOC.

Table of content: (NPI 1619237955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619237955 NPI number — ANDREW LEE THOMPSON DMD PC & ASSOC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDREW LEE THOMPSON DMD PC & ASSOC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTH PLAINS TENDERCARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619237955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10395 NW GLENCOE RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH PLAINS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97133-8208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-647-0055
Provider Business Mailing Address Fax Number:
503-647-0033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10395 NW GLENCOE RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PLAINS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97133-8208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-647-0055
Provider Business Practice Location Address Fax Number:
503-647-0033
Provider Enumeration Date:
05/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
503-647-0055

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  D7612 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com