| Thompson Medical Incorporated | |
|
4564 N Broadway St Chicago IL 60640-5602 | |
| (773) 271-9700 | |
| (773) 271-9700 |
| Full Name | Thompson Medical Incorporated |
|---|---|
| Speciality | Clinic/Center |
| Location | 4564 N Broadway St, Chicago, Illinois |
| Authorized Official Name and Position | Thompson Dzidza (PRESIDENT/OWNER) |
| Authorized Official Contact | 7732719700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thompson Medical Incorporated 4564 N Broadway St Chicago IL 60640-5602 Ph: (773) 271-9700 | Thompson Medical Incorporated 4564 N Broadway St Chicago IL 60640-5602 Ph: (773) 271-9700 |
| NPI Number | 1356814503 |
|---|---|
| Provider Enumeration Date | 01/09/2019 |
| Last Update Date | 01/10/2021 |
| Certification Date | 01/10/2021 |
| Medicare PECOS PAC ID | 4385979590 |
|---|---|
| Medicare Enrollment ID | O20190710002766 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356814503 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Byron F Reed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194872994 PECOS PAC ID: 9032016845 Enrollment ID: I20031218000242 |
| Provider Name | Emily Chatskis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790771434 PECOS PAC ID: 1456382514 Enrollment ID: I20050830000119 |
| Provider Name | Thompson Dzidza |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1174930887 PECOS PAC ID: 0143549030 Enrollment ID: I20150427001052 |
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