Basic Information
| Provider Information | |||||||||
| NPI: | 1740236694 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | BYRON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PILOT MEDICAL DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352353412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058562284 | ||||||||
| FaxNumber: | 2058154777 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 PILOT MEDICAL DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352353412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058154810 | ||||||||
| FaxNumber: | 2058154864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 01/06/2016 | ||||||||
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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 | 174400000X | 25087 | AL | N | Other Service Providers | Specialist | 207RC0000X | 25087 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1740236694 | 01 | AL | UHC | OTHER | 51522240 | 01 | AL | BCBS | OTHER | P00637078 | 01 | AL | RRMC | OTHER | 1740236694 | 05 | AL | MEDICAID | 5780115 | 01 | AL | CIGNA | OTHER |