Healthcare Provider Details

I. General information

NPI: 1497279897
Provider Name (Legal Business Name): TIMOTHY BARNES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 N DEARBORN ST
INDIANAPOLIS IN
46201-1412
US

IV. Provider business mailing address

1406 N DEARBORN ST
INDIANAPOLIS IN
46201-1412
US

V. Phone/Fax

Practice location:
  • Phone: 317-956-7748
  • Fax:
Mailing address:
  • Phone: 317-956-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: