Healthcare Provider Details

I. General information

NPI: 1619975240
Provider Name (Legal Business Name): TIMOTHY DALE HUME M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 EDMONTON RD
TOMPKINSVILLE KY
42167-9402
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 270-487-9272
  • Fax: 270-487-6242
Mailing address:
  • Phone: 270-864-1472
  • Fax: 270-858-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23892
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: