Healthcare Provider Details

I. General information

NPI: 1336589308
Provider Name (Legal Business Name): JON C THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 HARMONY RIDGE DR
GEORGETOWN KY
40324-9688
US

IV. Provider business mailing address

232 HARMONY RIDGE DR
GEORGETOWN KY
40324-9688
US

V. Phone/Fax

Practice location:
  • Phone: 270-304-6555
  • Fax:
Mailing address:
  • Phone: 270-304-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01074735A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number336.118272
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11017427A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number49301
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number49301
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: