Provider Demographics
NPI:1255389284
Name:THOMPSON, RANDALL C (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:C
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-7117
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4330 WORNALL RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5939
Practice Address - Country:US
Practice Address - Phone:816-931-1883
Practice Address - Fax:816-756-3645
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO109525207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00836137OtherRAILROAD MEDICARE
KSKA1021041OtherMEDICARE - CUSHING
KS100181680CMedicaid
KS100181680FMedicaid
KS100181680GMedicaid
MO208127209Medicaid
KSP00842695OtherRAILROAD MEDICARE
KS100181680DOtherMEDICAID - CUSHING
D50774Medicare UPIN
MO208127209Medicaid
KS100181680FMedicaid
KSKA1021041OtherMEDICARE - CUSHING
KSP00842695OtherRAILROAD MEDICARE