1447255682 NPI number — JAMES M. TIMONEY D.O.

Table of content: JOHN REAVES (NPI 1740080522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447255682 NPI number — JAMES M. TIMONEY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIMONEY
Provider First Name:
JAMES
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1447255682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
690 MINOT AVE
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04210-3922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-783-1328
Provider Business Mailing Address Fax Number:
207-795-0260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
690 MINOT AVE
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04210-3922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-783-1328
Provider Business Practice Location Address Fax Number:
207-795-0260
Provider Enumeration Date:
06/15/2005

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: 207X00000X , with the licence number:  1430 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DX3182 . This is a "NEW MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006985 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0378600001 . This is a "DMERC" identifier . This identifiers is of the category "OTHER".
  • Identifier: M4234 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100294000 . This is a "USPS WC" identifier . This identifiers is of the category "OTHER".
  • Identifier: MM0716 . This is a "MEDICARE CLINIC FACILITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010416156 . This is a "TRAVELERS/CORE/MEDNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1044480 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200020419 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201017 . This is a "MEDICARE ASC FACILITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: E08891 . This is a "HARVARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: MM4887 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 304050099 . This is a "MAINECARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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