Provider Demographics
NPI:1043480973
Name:TIMOTHY M WHEELER MD PSC
Entity type:Organization
Organization Name:TIMOTHY M WHEELER MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-329-2888
Mailing Address - Street 1:PO BOX 2437
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2437
Mailing Address - Country:US
Mailing Address - Phone:606-324-0016
Mailing Address - Fax:606-638-7384
Practice Address - Street 1:2483 HIGHWAY 644 STE 203
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230
Practice Address - Country:US
Practice Address - Phone:606-638-3813
Practice Address - Fax:606-638-7384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7392Medicare PIN