1134409790 NPI number — TIMOTHY A SPARKMAN O.D.

Table of content: TIMOTHY A SPARKMAN O.D. (NPI 1134409790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134409790 NPI number — TIMOTHY A SPARKMAN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPARKMAN
Provider First Name:
TIMOTHY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134409790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 296
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERGUSON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42533-0296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-492-2211
Provider Business Mailing Address Fax Number:
606-676-0873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3810 S HIGHWAY 27 STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42501-3073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-678-4551
Provider Business Practice Location Address Fax Number:
606-678-0972
Provider Enumeration Date:
08/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1850DT , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000840902 . This is a "ANTHEM SOMERSET" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0487990002 . This is a "MEDICARE DME WHITLEY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 5094 . This is a "AVESIS WHITLEY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100196570 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4104981 . This is a "TENNCARE WHITLEY" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7100209960 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015403 . This is a "BLOCK SOMERSET" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2416 . This is a "MEDICARE SOMERSET" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 5092 . This is a "AVESIS SOMERSET" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 8809 . This is a "MEDICARE WHITLEY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CP0230:009 . This is a "EYEMED WHITLEY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CP0230:010 . This is a "EYEMED SOMERSET" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CB8623 . This is a "RAILROAD MEDICARE KY OFFICES" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CJ5379 . This is a "RAILROAD MEDICARE TN OFFICES" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000840905 . This is a "ANTHEM WHITLEY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0487990006 . This is a "MEDICARE DME SOMERSET" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 154471 . This is a "TENNCARE SOMERSET" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7100212600 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com