MEDICARE: CANDICE MARIA TIMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	2719064	DC

General Provider Information

NPI Number	:	1396277851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE MARIA TIMS

Provider Business Mailing Address
First Line	:	4209 GAULT PL NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019
Country	:	US
Telephone Number	:	240-779-7113
Fax Number	:

Provider Business Practice Location Address
First Line	:	4209 GAULT PL NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-8006
Country	:	US
Telephone Number	:	240-779-7113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	04/03/2017

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Directions to “ CANDICE MARIA TIMS ” Practice Location

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