1801833892 NPI number — DR. CARENA MAY THOMPSON D.O.

Table of content: DR. CARENA MAY THOMPSON D.O. (NPI 1801833892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801833892 NPI number — DR. CARENA MAY THOMPSON D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
CARENA
Provider Middle Name:
MAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLACKETER
Provider Other First Name:
CARENA
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801833892
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. DRAWER 367
Provider Second Line Business Mailing Address:
NIMIIPUU HEALTH, 111 BEAVER GRADE ROAD
Provider Business Mailing Address City Name:
LAPWAI
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83540-0367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-843-2842
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 BEAVER GRADE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAPWAI
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83540-0367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-843-2842
Provider Business Practice Location Address Fax Number:
309-527-3525
Provider Enumeration Date:
05/31/2006

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: 207Q00000X , with the licence number:  3676 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 036123865 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 336.086682 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 336086682 . This is a "ILLINOIS CONTROLLED SUBSTANCE #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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