Healthcare Provider Details

I. General information

NPI: 1871836742
Provider Name (Legal Business Name): THOMSON MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 W CENTRAL AVE
CAMDEN OH
45311-1007
US

IV. Provider business mailing address

PO BOX 39
CAMDEN OH
45311-0039
US

V. Phone/Fax

Practice location:
  • Phone: 937-452-1201
  • Fax: 937-452-0004
Mailing address:
  • Phone: 937-452-1201
  • Fax: 937-452-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEREK W THOMSON
Title or Position: OWNER
Credential: DO
Phone: 937-452-1201