1649556218 NPI number — MEGAN MARIE THOMPSON PAC

Table of content: ELAINE BARRETT (NPI 1639596364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649556218 NPI number — MEGAN MARIE THOMPSON PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
MEGAN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TALBOTT
Provider Other First Name:
MEGAN
Provider Other Middle Name:
MARIE
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:
1649556218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 449
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45750-0449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-374-4500
Provider Business Mailing Address Fax Number:
740-374-5887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 PIKE ST STE 2
Provider Second Line Business Practice Location Address:
EXPRESS CARE MARIETTA
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45750-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-373-3960
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2011

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:  552 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 50.003453 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 50.003453RX , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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