1962407288 NPI number — WILLIAM THIEMKEY D.O.

Table of content: WILLIAM THIEMKEY D.O. (NPI 1962407288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962407288 NPI number — WILLIAM THIEMKEY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THIEMKEY
Provider First Name:
WILLIAM
Provider Middle Name:
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:
1962407288
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 HUNTING LODGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLACK MOUNTAIN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28711-9799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-669-4485
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NAPLES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLETCHER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-681-2141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2005

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: 207P00000X , with the licence number:  2005-01802 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: WT007666 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5903338 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1373910 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00418628 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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