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NPI Code Detail

MEDICARE: JEAN THOMPSON PA

MEDICARE: JEAN THOMPSON PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0069SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659353282
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEAN THOMPSON PA
Provider Business Mailing Address
First Line : 172 4TH ST SE
Second Line :
City : HURON
State : SD
Zip : 57350-2510
Country : US
Telephone Number : 605-353-6200
Fax Number : 605-353-6593
Provider Business Practice Location Address
First Line : 172 4TH ST SE
Second Line :
City : HURON
State : SD
Zip : 57350-2510
Country : US
Telephone Number : 605-353-6200
Fax Number : 605-353-6593
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2005
Last Update Date : 07/08/2007

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