Basic Information
Provider Information
NPI: 1710921895
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THIGPEN
FirstName: JAMES
MiddleName: TATE
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2500 NORTH STATE STREET
Address2: DIVISION OF ONCOLOGY
City: JACKSON
State: MS
PostalCode: 392164500
CountryCode: US
TelephoneNumber: 6019845590
FaxNumber: 6019845599
Practice Location
Address1: 2500 NORTH STATE STREET
Address2: DEPARTMENT OF MEDICINE/DIVISION OF ONCOLOGY
City: JACKSON
State: MS
PostalCode: 392164500
CountryCode: US
TelephoneNumber: 6019845590
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/16/2006
LastUpdateDate: 04/09/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RX0202X05853MSY Allopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology

ID Information
IDTypeStateIssuerDescription
001745105MS MEDICAID
10084105AL MEDICAID
118321105LA MEDICAID
RR 90000110801MSRAILROADOTHER


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