1184602831 NPI number — CARL THOMPSON DO

Table of content: CARL THOMPSON DO (NPI 1184602831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184602831 NPI number — CARL THOMPSON DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
CARL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1184602831
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10820 PARKSIDE DR
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37934-1956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-218-7972
Provider Business Mailing Address Fax Number:
865-218-7973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10820 PARKSIDE DR
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37934-1956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-218-7972
Provider Business Practice Location Address Fax Number:
865-218-7973
Provider Enumeration Date:
01/04/2006

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: 208M00000X , with the licence number:  1705 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 2010-00194 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 2010-00194 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: NC1127 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4106087 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3718274 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5914677 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7334697 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00241596 . This is a "PALMETTO GBA-RR MCR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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