Basic Information
| Provider Information | |||||||||
| NPI: | 1922042233 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STEPHEN C. THOMPSON, M.D.,S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9726 | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616129726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096921700 | ||||||||
| FaxNumber: | 3096921771 | ||||||||
| Practice Location | |||||||||
| Address1: | 5401 N KNOXVILLE AVE | ||||||||
| Address2: | SUITE 119 | ||||||||
| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616145098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096921700 | ||||||||
| FaxNumber: | 3096921771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 04/09/2014 | ||||||||
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| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3096921700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 036076612 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.