Healthcare Provider Details

I. General information

NPI: 1023073699
Provider Name (Legal Business Name): WILLIAM CYRUS THOMPSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MAIN ST.
MONROE CITY IN
47557-0006
US

IV. Provider business mailing address

PO BOX 6 1201 MAIN ST.
MONROE CITY IN
47557-0006
US

V. Phone/Fax

Practice location:
  • Phone: 812-743-5113
  • Fax: 812-743-2748
Mailing address:
  • Phone: 812-743-5113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02000689
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: