MEDICARE: GREG THOMPSON

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
1	237700000X	Hearing Instrument Specialist	0960	KY

General Provider Information

NPI Number	:	1841543790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREG THOMPSON

Provider Business Mailing Address
First Line	:	131 ENTERPRISE RD
Second Line	:
City	:	JOHNSTOWN
State	:	NY
Zip	:	12095-3326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 W PARRISH AVE
Second Line	:	STE 400
City	:	OWENSBORO
State	:	KY
Zip	:	42301-3519
Country	:	US
Telephone Number	:	270-683-7173
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2012
Last Update Date	:	10/16/2012

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