Provider Demographics
NPI:1104934231
Name:THOMPSON COMPANY OF MISSISSIPPI
Entity type:Organization
Organization Name:THOMPSON COMPANY OF MISSISSIPPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-346-4117
Mailing Address - Street 1:110 SOUTHPOINTE DR STE C
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-5571
Mailing Address - Country:US
Mailing Address - Phone:601-346-4117
Mailing Address - Fax:601-346-4118
Practice Address - Street 1:110 SOUTHPOINTE DR STE C
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-5571
Practice Address - Country:US
Practice Address - Phone:601-346-4117
Practice Address - Fax:601-346-4118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00085201Medicaid
MS4826210001Medicare ID - Type UnspecifiedPROVIDER