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General NPI Number Information
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NPI Number | 1114372125
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Entity Type | Organization
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Legal Business Name | THOMPSON FAMILY PRACTICE
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 2222 S 16TH ST SUITE 435
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City | LINCOLN
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State | NE
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Zip | 68502-6796
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Country | US
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Telephone | 402-474-7445
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Fax | 402-474-4792
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Provider Business Mailing Address
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Address Line | 2222 S 16TH ST STE 435
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City | LINCOLN
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State | NE
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Zip | 68502-3793
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Country | US
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Telephone | 402-474-7445
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Fax | 402-474-4792
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Authorized Official
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Title or Position | MANAGER
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Name | JODIE K VALISH
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Credential |
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Telephone | 402-474-7445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 27949
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License Number State | NE
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