Basic Information
| Provider Information | |||||||||
| NPI: | 1396954749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2447 | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354032447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053450192 | ||||||||
| FaxNumber: | 2052472194 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 PAUL BRYANT DRIVE | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354012055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053450192 | ||||||||
| FaxNumber: | 2052472194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 10/26/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2009-00524 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 2009-00524 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | MD.27183 | AL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | MD.27183 | AL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 51105893 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 51105891 | 01 | AL | BLUE CROSS BLUE SHIELD OF ALABAMA | OTHER | 119855 | 05 | AL | MEDICAID | 119857 | 05 | AL | MEDICAID | 118894 | 05 | AL | MEDICAID | 51105892 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER |