1295750107 NPI number — KISHORE THAMPY, M.D.,S.C.

Table of content: JOSCELINE CLARISSA DOMINGUEZ HS (NPI 1447923453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295750107 NPI number — KISHORE THAMPY, M.D.,S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KISHORE THAMPY, M.D.,S.C.
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:
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:
1295750107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 388320
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60638-8320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-767-4600
Provider Business Mailing Address Fax Number:
776-767-8320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1955 US 1 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST AUGUSTINE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32086-3708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-599-9396
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THAMPY
Authorized Official First Name:
KISHORE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
563-584-2324

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45495 . This is a "BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 260025865 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 021604125 . This is a "BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1133389 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036048133 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00134680 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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