1760407514 NPI number — MR. DAVID ALAN THOMPSON PA-C

Table of content: MR. DAVID ALAN THOMPSON PA-C (NPI 1760407514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760407514 NPI number — MR. DAVID ALAN THOMPSON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
DAVID
Provider Middle Name:
ALAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1760407514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 S CLEVELAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43081-1397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-890-6555
Provider Business Mailing Address Fax Number:
614-823-7075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5040 FOREST DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43054-8167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-890-6555
Provider Business Practice Location Address Fax Number:
614-881-1484
Provider Enumeration Date:
07/13/2006

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: 363AS0400X , with the licence number:  50.002734 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001865414 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00364552 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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