Organization
THOMPSON FIRST SURGICAL ASSISTING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLEN THOMPSON III CSA (OWNER)
(859) 200-3356
Entity
Organization
Contact information
Practice address
138 RAVEN DR, BEREA, KY 40403
(859) 200-3356
(502) 451-9291
Mailing address
138 RAVEN DR, BEREA, KY 40403
(859) 200-3356
(502) 451-9291
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
2222
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000493588
ANTHEM
KY
Enumeration date
05/03/2007
Last updated
08/22/2020
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