Basic Information
| Provider Information | |||||||||
| NPI: | 1144219544 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3601 4TH ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794305865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432340 | ||||||||
| FaxNumber: | 8067433121 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 4TH ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794300002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432340 | ||||||||
| FaxNumber: | 8067433121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | H6650 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0027WA | 01 | TX | BLUE CROSS | OTHER | 2174020 | 01 | TX | CIGNA | OTHER | 100177803 | 05 | TX | MEDICAID |