MEDICARE: DR. TIMOTHY C. HODGES MD

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	2086S0129X	Vascular Surgery Physician	113383	MO
2	2086S0129X	Vascular Surgery Physician	0428604	KS
3	2086S0129X	Vascular Surgery Physician	MD201655	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00153164	OTHER	MO	R R MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457441339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY C. HODGES MD

Provider Business Mailing Address
First Line	:	665 WINTER ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-3934
Country	:	US
Telephone Number	:	503-814-8272
Fax Number	:

Provider Business Practice Location Address
First Line	:	665 WINTER ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-3934
Country	:	US
Telephone Number	:	503-814-8272
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	05/08/2023

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Directions to “ DR. TIMOTHY C. HODGES MD” Practice Location

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