Kenneth Thompson
Individual provider Active NPI Driver · Philadelphia, PA
NPI 1093476954 · NPPES record last updated Jan 4, 2022
Key facts
- NPI
- 1093476954
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- Practice address
- 5416 Florence Ave
Philadelphia, PA 19143-4139 - Phone
- (267) 826-6125
- NPI assigned
- Jan 4, 2022
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| We Bring Hope | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver |
172A00000X | PA | Yes |
Addresses
Primary practice location
5416 Florence Ave
Philadelphia, PA 19143-4139
Mailing address
5416 Florence Ave
Philadelphia, PA 19143-4139
Phone (267) 826-6125
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1039407360001 | Medicaid | PA |
Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.