1043296957 NPI number — GREGORY L THOMPSON MD

Table of content: GREGORY L THOMPSON MD (NPI 1043296957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043296957 NPI number — GREGORY L THOMPSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
GREGORY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1043296957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3340 PLAYERS CLUB PKWY STE 350
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38125-8949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-207-2032
Provider Business Mailing Address Fax Number:
844-752-2164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 BELK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-232-8100
Provider Business Practice Location Address Fax Number:
662-513-1496
Provider Enumeration Date:
12/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  24465 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 21416 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 127556001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207821406 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3077001 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3077737 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50046030 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00125621 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 97195 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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