1194838938 NPI number — MR. RUSSELL C THOMPSON MD

Table of content: MR. RUSSELL C THOMPSON MD (NPI 1194838938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194838938 NPI number — MR. RUSSELL C THOMPSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
RUSSELL
Provider Middle Name:
C
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1194838938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1623 HASLETT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HASLETT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-339-2100
Provider Business Mailing Address Fax Number:
517-339-4620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1623 HASLETT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASLETT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-614-1104
Provider Business Practice Location Address Fax Number:
517-694-1692
Provider Enumeration Date:
08/16/2006

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: 207R00000X , with the licence number:  4301407218 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7388025 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700C312390 . This is a "BCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6600006 . This is a "PHP" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com