1376941740 NPI number — MR. EVAN SCOTT THOMPSON PA-C, ATC, AEMT

Table of content: MR. EVAN SCOTT THOMPSON PA-C, ATC, AEMT (NPI 1376941740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376941740 NPI number — MR. EVAN SCOTT THOMPSON PA-C, ATC, AEMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
EVAN
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C, ATC, AEMT
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:
1376941740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1260 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03101-1305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-314-1701
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEENE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03431-1729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-354-5400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2014

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: 207PE0004X , with the licence number:  30091 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2255A2300X , with the licence number: 0555 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 2009 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0555 . This is a "NH STATE ATHLETIC TRAINING LICENSE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30091A . This is a "NH DEPT. OF SAFETY; DIVISION OF FIRE STANDARDS & TRAINING AND EMS; BUREAU OF EMS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2000012822 . This is a "BOARD OF CERTIFICATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: A2022946 . This is a "NATIONAL REGISTRY OF EMERGENCY MEDICAL TECHNICIANS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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