1417483595 NPI number — MR. TIMOTHY K URQUHART RN, BSN

Table of content: MR. TIMOTHY K URQUHART RN, BSN (NPI 1417483595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417483595 NPI number — MR. TIMOTHY K URQUHART RN, BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
URQUHART
Provider First Name:
TIMOTHY
Provider Middle Name:
K
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN
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:
1417483595
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURAND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61024-8912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-821-4217
Provider Business Mailing Address Fax Number:
855-274-8523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61024-8912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-821-4217
Provider Business Practice Location Address Fax Number:
855-274-8523
Provider Enumeration Date:
05/10/2017

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: 146L00000X , with the licence number:  0000344697 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: 041.413981 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com