MEDICARE: KEITH THOMPSON MD

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	208600000X	Surgery Physician	18049	MS
2	208600000X	Surgery Physician	29386	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36655	OTHER	TN	TLC
2	000000188621	OTHER	TN	UNISON
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4128847	OTHER	TN	BCBS
6	4383459	OTHER	TN	AETNA

General Provider Information

NPI Number	:	1215997077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH THOMPSON MD

Provider Business Mailing Address
First Line	:	143 KENNEDY DR
Second Line	:	SUITE A
City	:	MARTIN
State	:	TN
Zip	:	38237-3309
Country	:	US
Telephone Number	:	731-587-5321
Fax Number	:	731-587-2145

Provider Business Practice Location Address
First Line	:	143 KENNEDY DR
Second Line	:	SUITE A
City	:	MARTIN
State	:	TN
Zip	:	38237-3309
Country	:	US
Telephone Number	:	731-587-5321
Fax Number	:	731-587-2145

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	10/09/2008

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Directions to “ KEITH THOMPSON MD” Practice Location

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