Basic Information
| Provider Information | |||||||||
| NPI: | 1003834649 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | JEANNE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 950202 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029696552 | ||||||||
| FaxNumber: | 5029693799 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 AUDUBON PLAZA DR | ||||||||
| Address2: | LL2 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402171319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026368095 | ||||||||
| FaxNumber: | 5026368097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 07/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01052521 | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RB0002X | 41076 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Bariatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2852889000 | 01 | KY | PASSPORT ADVANTAGE- NORTON CMA | OTHER | 50015382 | 01 | KY | PASSPORT- NORTON CMA | OTHER | 000000520350 | 01 | KY | ANTHEM- NORTON CMA | OTHER | 086789 | 01 | KY | SIHO- NORTON CMA | OTHER | 9740797 | 01 | KY | CIGNA- NORTON CMA | OTHER | P00400038 | 01 | KY | RAILROARD MEDICARE - KY | OTHER | 200249650 | 01 | IN | MEDICAID INDIANA- NORTON CMA | OTHER | 7100008310 | 05 | KY | MEDICAID |