Healthcare Provider Details

I. General information

NPI: 1427064799
Provider Name (Legal Business Name): TIMOTHY ADAM CALLAHAN P.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 E HIGHWAY 123
SUNNYSIDE UT
84539-7725
US

IV. Provider business mailing address

PO BOX 930
EAST CARBON UT
84520-0930
US

V. Phone/Fax

Practice location:
  • Phone: 435-888-4411
  • Fax: 435-888-2270
Mailing address:
  • Phone: 435-888-4411
  • Fax: 435-888-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number314106-8906
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number314106-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: