1922469519 NPI number — MR. TIMOTHY JOSEPH WAUGH JR. ATC

Table of content: MR. TIMOTHY JOSEPH WAUGH JR. ATC (NPI 1922469519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922469519 NPI number — MR. TIMOTHY JOSEPH WAUGH JR. ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAUGH
Provider First Name:
TIMOTHY
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WAUGH
Provider Other First Name:
JOEY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1922469519
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5638 GLEN CARLA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25705-2102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-393-1417
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 UNIVERSITY PLZ
Provider Second Line Business Practice Location Address:
MS0200
Provider Business Practice Location Address City Name:
CAPE GIRARDEAU
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63701-4710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-393-1417
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2016

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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