Glen Thompson III, CSA

Primary specialty

Surgical TechnologistTaxonomy code 246ZS0410X

License

2222 Issued in KY

Practice address

138 Raven Dr
Berea, KY 40403

Phone

(859) 200-3356

Fax

(502) 451-9291

NPI assigned

May 1, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Thompson First Surgical Assisting

  • Surgical Technologist
  • Berea, KY
  • NPI 1881816130
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629299268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 RAVEN DR",
            "city": "BEREA",
            "state": "KY",
            "postal_code": "40403",
            "telephone_number": "859-200-3356",
            "fax_number": "502-451-9291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 RAVEN DR",
            "city": "BEREA",
            "state": "KY",
            "postal_code": "40403",
            "telephone_number": "859-200-3356",
            "fax_number": "502-451-9291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "GLEN",
        "name_suffix": "III",
        "credential": "CSA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": "KY",
            "license": "2222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000493588",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Speech Path PLLC
• The Speech Path PLLC
• Therapy With Alix
• Thompson Drug Kingston Inc
• Thompson First Surgical Assisting
• Jennifer Thompson, MSN, APRN, PMHNP-BC
• Frances Alexis Tillery, PT, DPT
• Today'S Family Dental
• Toddler Talk: Speech-Language Pathology
• Erica Branham Trimble, APRN

• Surgical Technologist in Berea, KY
• Providers in Berea, KY by specialty
• Surgical Technologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.