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NPI Code Detail

MEDICARE: MACKENZIE THOMPSON

MEDICARE: MACKENZIE 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
1363A00000XPhysician Assistant085.009328IL

General Provider Information

NPI Number : 1972210995
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE THOMPSON
Provider Business Mailing Address
First Line : 730 N BOONE ST
Second Line :
City : OLNEY
State : IL
Zip : 62450-2054
Country : US
Telephone Number : 231-233-4690
Fax Number :
Provider Business Practice Location Address
First Line : 363 N WEST ST
Second Line :
City : OLNEY
State : IL
Zip : 62450-1160
Country : US
Telephone Number : 618-392-9400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2022
Last Update Date : 10/31/2022

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Directions to “ MACKENZIE THOMPSON ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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