1366447450 NPI number — TIMOTHY O WORKMAN DO

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366447450 NPI number — TIMOTHY O WORKMAN DO

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

WORKMAN

Provider First Name:

TIMOTHY

Provider Middle Name:

O

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

DO

Provider Gender Code:

M

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:

1366447450

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/24/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 457

Provider Second Line Business Mailing Address:

200 POCAHONTAS TRAIL

Provider Business Mailing Address City Name:

WHITE SULPHUR SPRINGS

Provider Business Mailing Address State Name:

WV

Provider Business Mailing Address Postal Code:

24986-0457

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

304-536-5030

Provider Business Mailing Address Fax Number:

304-536-5031

Provider First Line Business Practice Location Address:

296 FAIR ST.

Provider Second Line Business Practice Location Address:

TIMOTHY O. WORKMAN, MD

Provider Business Practice Location Address City Name:

LEWISBURG

Provider Business Practice Location Address State Name:

WV

Provider Business Practice Location Address Postal Code:

24901-2632

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

304-647-4747

Provider Business Practice Location Address Fax Number:

304-647-4293

Provider Enumeration Date:

06/16/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  1202 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 541839718 . This is a "C&O" identifier . This identifiers is of the category "OTHER".
• Identifier: 200026 . This is a "LUNG" identifier . This identifiers is of the category "OTHER".
• Identifier: 236403117 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 5181993 . This is a "CCN" identifier . This identifiers is of the category "OTHER".
• Identifier: 58246 . This is a "CARELINK" identifier . This identifiers is of the category "OTHER".
• Identifier: 5916968 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 58246 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 541839718011 . This is a "BS MOUNTAIN STATE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 0042092000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 005630797 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 245039 . This is a "ANTHEM" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 4539949 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 454181 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".