MEDICARE: ALBERT P. 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	261QR1300X	Rural Health Clinic/Center	383828	OR

Other Identifiers

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

General Provider Information

NPI Number	:	1871591016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBERT P. THOMPSON

Provider Business Mailing Address
First Line	:	PO BOX 655
Second Line	:
City	:	PACIFIC CITY
State	:	OR
Zip	:	97135-0655
Country	:	US
Telephone Number	:	503-965-6555
Fax Number	:	503-965-6800

Provider Business Practice Location Address
First Line	:	38505 BROOTEN RD.
Second Line	:	SUITE A
City	:	PACIFIC CITY
State	:	OR
Zip	:	97135
Country	:	US
Telephone Number	:	503-965-6555
Fax Number	:	503-965-6800

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	M SYDNEY THOMPSON
Credential	:
Telephone Number	:	503-965-6555

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	08/22/2020

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