Healthcare Provider Details

I. General information

NPI: 1508954926
Provider Name (Legal Business Name): VALERIE S THOMPSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 OLD JACKSONVILLE RD SUITE B4
SPRINGFIELD IL
62704-7437
US

IV. Provider business mailing address

2901 OLD JACKSONVILLE RD SUITE B4
SPRINGFIELD IL
62704-7437
US

V. Phone/Fax

Practice location:
  • Phone: 217-241-3586
  • Fax: 217-241-3589
Mailing address:
  • Phone: 217-241-3586
  • Fax: 217-241-3589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-115383
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: