1912762626 NPI number — STEVEN THOMPSON III PTA

Table of content: STEVEN THOMPSON III PTA (NPI 1912762626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912762626 NPI number — STEVEN THOMPSON III PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
STEVEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
PTA
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:
1912762626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 234
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRIENDSHIP
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-701-7841
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91 CAMDEN ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
ROCKLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-596-0133
Provider Business Practice Location Address Fax Number:
207-596-0144
Provider Enumeration Date:
02/21/2024

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: 225200000X , with the licence number:  PA6571 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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