Healthcare Provider Details

I. General information

NPI: 1164539367
Provider Name (Legal Business Name): DIANE SIMS THOMPSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 PROFESSIONAL PL STE 101
COLORADO SPRINGS CO
80904-8125
US

IV. Provider business mailing address

PO BOX 911057
DENVER CO
80291-1057
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-6850
  • Fax: 719-776-6855
Mailing address:
  • Phone: 888-269-7001
  • Fax: 303-764-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0049988
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: