MEDICARE: COREY L THOMPSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	AZ 2069	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	HN3Z0381	OTHER	AZ	AZ HEALTHNET
3	AZ0147940	OTHER	AZ	AZ BCBS
4	AW7564	OTHER	AZ	AZ HEALTHNET

General Provider Information

NPI Number	:	1134148513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY L THOMPSON PA-C

Provider Business Mailing Address
First Line	:	4340 E INDIAN SCHOOL RD
Second Line	:	STE 21-562
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5360
Country	:	US
Telephone Number	:	480-545-2610
Fax Number	:	480-545-2673

Provider Business Practice Location Address
First Line	:	4340 E INDIAN SCHOOL RD
Second Line	:	STE 21-562
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5360
Country	:	US
Telephone Number	:	480-545-2610
Fax Number	:	480-545-2673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	12/22/2014

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Directions to “ COREY L THOMPSON PA-C” Practice Location

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