1568181386 NPI number — TIMOTHY JOHN KATHOL

Table of content: TIMOTHY JOHN KATHOL (NPI 1568181386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568181386 NPI number — TIMOTHY JOHN KATHOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KATHOL
Provider First Name:
TIMOTHY
Provider Middle Name:
JOHN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1568181386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9902 270TH ST NW STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STANWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98292-8091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-680-1869
Provider Business Mailing Address Fax Number:
564-204-1107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9902 270TH ST NW STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98292-8091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-680-1869
Provider Business Practice Location Address Fax Number:
564-204-1107
Provider Enumeration Date:
08/24/2022

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: 225700000X , with the licence number:  MA61323404 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MA61323404 . This is a "LMT" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com