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1386738508 NPI number — TIM THISTLETHWAITE, M.D. PLLC

NPI Number: 1386738508
Health Care Provider/Practitioner: TIM THISTLETHWAITE, M.D. PLLC

Information about “1386738508” NPI (TIM THISTLETHWAITE, M.D. PLLC) exists in 1386738508 in HTML format HTML  |  1386738508 in plain Text format TXT  |  1386738508 in PDF (Portable Document Format) PDF  |  1386738508 in an XML format XML  formats.

NPI Number : 1386738508 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1386738508",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "TIM THISTLETHWAITE, M.D. PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "100 PEYTON WAY",
    "SecondLineMailingAddress": "SUITE 100",
    "MailingAddressCityName": "CHARLESTON",
    "MailingAddressStateName": "WV",
    "MailingAddressPostalCode": "25309-8767",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "304-205-5207",
    "MailingAddressFaxNumber": "304-205-5318",
    "FirstLinePracticeLocationAddress": "100 PEYTON WAY",
    "SecondLinePracticeLocationAddress": "SUITE 100",
    "PracticeLocationAddressCityName": "CHARLESTON",
    "PracticeLocationAddressStateName": "WV",
    "PracticeLocationAddressPostalCode": "25309-8767",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "304-205-5207",
    "PracticeLocationAddressFaxNumber": "304-205-5318",
    "EnumerationDate": "10/03/2006",
    "LastUpdateDate": "10/04/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "THISTLETHWAITE",
    "AuthorizedOfficialFirstName": "TIM",
    "AuthorizedOfficialMiddleName": "L",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "304-205-5207",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "1225",
          "LicenseNumberStateCode": "WV",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "17498",
          "LicenseNumberStateCode": "WV",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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