Basic Information
| Provider Information | |||||||||
| NPI: | 1831113752 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | ARLISS | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 20190 | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820037004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076355393 | ||||||||
| FaxNumber: | 3076352199 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 W 69TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571088148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076355393 | ||||||||
| FaxNumber: | 3076352199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 02/09/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 6917A | WY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207PE0004X | 3438 | SD | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207R00000X | 3438 | SD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | 3438 | SD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 118742200 | 05 | WY | MEDICAID | 6002984 | 05 | SD | MEDICAID | P00056204S | 01 | SD | RAILROAD ID | OTHER | 4993306 | 01 | SD | SD BCBS | OTHER | 312263 | 01 | WY | BLUE SHIELD | OTHER | 82601D032 | 01 | WY | WPS TRIWEST | OTHER |