MEDICARE: MR. EVAN SCOTT THOMPSON PA-C, ATC, AEMT

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	30091	NH
2	2255A2300X	Athletic Trainer	0555	NH
3	363A00000X	Physician Assistant	2009	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0555	OTHER	NH	NH STATE ATHLETIC TRAINING LICENSE
2	30091A	OTHER	NH	NH DEPT. OF SAFETY; DIVISION OF FIRE STANDARDS & TRAINING AND EMS; BUREAU OF EMS
3	2000012822	OTHER		BOARD OF CERTIFICATION
4	A2022946	OTHER	NH	NATIONAL REGISTRY OF EMERGENCY MEDICAL TECHNICIANS

General Provider Information

NPI Number	:	1376941740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EVAN SCOTT THOMPSON PA-C, ATC, AEMT

Provider Business Mailing Address
First Line	:	1260 ELM ST
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03101-1305
Country	:	US
Telephone Number	:	603-314-1701
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 COURT ST
Second Line	:
City	:	KEENE
State	:	NH
Zip	:	03431-1729
Country	:	US
Telephone Number	:	603-354-5400
Fax Number	:

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

Provider Enumeration Date	:	12/16/2014
Last Update Date	:	05/04/2023

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Directions to “ MR. EVAN SCOTT THOMPSON PA-C, ATC, AEMT” Practice Location

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