MEDICARE: DIANE SIMS THOMPSON M.D.

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	2084P0800X	Psychiatry Physician	DR.0049988	CO

General Provider Information

NPI Number	:	1164539367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE SIMS THOMPSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 911057
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80291-1057
Country	:	US
Telephone Number	:	888-269-7001
Fax Number	:	303-764-6640

Provider Business Practice Location Address
First Line	:	2925 PROFESSIONAL PL STE 101
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-8125
Country	:	US
Telephone Number	:	719-776-6850
Fax Number	:	719-776-6855

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	05/01/2018

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