Provider Demographics
NPI:1871535187
Name:THOMPSON ORTHOPEDIC CLINIC, PA
Entity type:Organization
Organization Name:THOMPSON ORTHOPEDIC CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:979-297-3004
Mailing Address - Street 1:201 OAK DR S
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5676
Mailing Address - Country:US
Mailing Address - Phone:979-297-3004
Mailing Address - Fax:979-299-1301
Practice Address - Street 1:201 OAK DR S
Practice Address - Street 2:SUITE 104
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5676
Practice Address - Country:US
Practice Address - Phone:979-297-3004
Practice Address - Fax:979-299-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7333207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DB8385OtherRAILROAD MEDICARE
DB8385OtherRAILROAD MEDICARE
0887970001Medicare NSC
00118RMedicare ID - Type Unspecified