=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326296799
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TIMOTHY D. HUME M.D. LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2008
-----------------------------------------------------
Last Update Date | 06/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 710 N MAIN ST
-----------------------------------------------------
City | TOMPKINSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42167-1130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-487-8667
-----------------------------------------------------
Fax | 270-487-9505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 N MAIN ST
-----------------------------------------------------
City | TOMPKINSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42167-1130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-487-8667
-----------------------------------------------------
Fax | 270-487-9505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. PATRICIA ANN HUME
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 270-487-8667
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 23892
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------