MEDICARE: EDWARD THOMPSON

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1275172991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD THOMPSON

Provider Business Mailing Address
First Line	:	7373 BROOKCREST DR # RC333
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-3446
Country	:	US
Telephone Number	:	404-512-0544
Fax Number	:

Provider Business Practice Location Address
First Line	:	7373 BROOKCREST DR # RC333
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-3446
Country	:	US
Telephone Number	:	404-512-0544
Fax Number	:

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

Provider Enumeration Date	:	12/27/2019
Last Update Date	:	12/27/2019

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Directions to “ EDWARD THOMPSON ” Practice Location

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