Healthcare Provider Details

I. General information

NPI: 1215856570
Provider Name (Legal Business Name): FITZWILLIAM THOMPSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3671 NW 91ST LN # 3671
SUNRISE FL
33351-6455
US

IV. Provider business mailing address

3671 NW 91ST LN # 3671
SUNRISE FL
33351-6455
US

V. Phone/Fax

Practice location:
  • Phone: 954-592-3808
  • Fax:
Mailing address:
  • Phone: 954-592-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: FITZWILLIAM KNYKUSHI THOMPSON
Title or Position: OWNER
Credential:
Phone: 954-592-3808