Type | Person | [sources] | |||
---|---|---|---|---|---|
Name | Robert Clayton Thompson, Jr. | [sources] | |||
Birth date | not available | [sources] | |||
Nationality | not available | [sources] | |||
Country | United States | [sources] | |||
First name | Robert Clayton | [sources] | |||
Last name | Thompson, Jr. | [sources] | |||
NPI | 1699837294 | [sources] | |||
Address | 238 Colfox Camp Road, Fairmont, WV 26554 | [sources] | |||
Last change | Last processed | First seen |
Medicaid providers sanctioned in West Virginia's Medicaid program.
United States of America · MMIS
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Sanctions | |||||
---|---|---|---|---|---|
Country | Authority | Program | Start date | End date | |
United States | Medicaid Management Information System | - |
Address | ||
---|---|---|
Full address | Country | |
238 Colfox Camp Road, Fairmont, WV 26554 | United States |