1477669075 NPI number — DWIGHT E THOMPSON PA-C

Table of content: DWIGHT E THOMPSON PA-C (NPI 1477669075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477669075 NPI number — DWIGHT E THOMPSON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
DWIGHT
Provider Middle Name:
E
Provider Name Prefix Text:
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:
1477669075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N OAK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWNSEND
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59644-2306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-266-5204
Provider Business Mailing Address Fax Number:
406-266-4428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 3RD ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLOWTON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59036-0287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-632-4351
Provider Business Practice Location Address Fax Number:
406-632-3172
Provider Enumeration Date:
08/23/2006

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: 363A00000X , with the licence number:  82 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0432458 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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