Healthcare Provider Details

I. General information

NPI: 1104902121
Provider Name (Legal Business Name): OWEN R. THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 2ND ST SE
BARNESVILLE MN
56514-0279
US

IV. Provider business mailing address

712 S CASCADE ST
FERGUS FALLS MN
56537-2913
US

V. Phone/Fax

Practice location:
  • Phone: 218-354-2111
  • Fax: 218-354-2114
Mailing address:
  • Phone: 218-736-8000
  • Fax: 218-739-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25582
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: