1417010075 NPI number — THOMPSON PLASTIC SURGERY ASSOCIATES, LLC

Table of content: (NPI 1417010075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417010075 NPI number — THOMPSON PLASTIC SURGERY ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMPSON PLASTIC SURGERY ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1417010075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
FOXBORO
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02035-1021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-698-0888
Provider Business Mailing Address Fax Number:
508-698-0889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
FOXBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02035-1021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-698-0888
Provider Business Practice Location Address Fax Number:
508-698-0889
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD CERTIFIED PLASTIC SURGEON
Authorized Official Telephone Number:
508-698-0888

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  209748 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5967055 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 413768 . This is a "BLUECHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: M19277 . This is a "BLUE CROSS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 31896-5 . This is a "BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 419335 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 608893 . This is a "FALLON COM. HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 11167384 . This is a "CAQH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0143880 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA70338 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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