Healthcare Provider Details

I. General information

NPI: 1346632726
Provider Name (Legal Business Name): H.O. THOMPSON JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 HENDERSON ST
COLUMBIA SC
29201-2600
US

IV. Provider business mailing address

1730 HENDERSON ST
COLUMBIA SC
29201-2600
US

V. Phone/Fax

Practice location:
  • Phone: 803-736-2600
  • Fax: 803-799-6434
Mailing address:
  • Phone: 803-736-2600
  • Fax: 803-799-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD9101
License Number StateSC

VIII. Authorized Official

Name: HERMAN O THOMPSON JR.
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 803-765-2600