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1093799603

NPI Code Detail

MEDICARE: TIMOTHY BACHENBERG MD

MEDICARE: TIMOTHY BACHENBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34448	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06Q36BA	OTHER	MN	BLUE CROSS
2	7293	OTHER	MN	AVERA
3	23346	OTHER	MN	SIOUX VALLEY
4	604566	OTHER	MN	ARAZ
5	HP29866	OTHER	MN	HEALTHPARTNERS
6	01-13050	OTHER	MN	MEDICA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MH9041001734	OTHER	MN	PREFERREDONE
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	A021	OTHER	MN	CHAMPUS

General Provider Information

NPI Number	:	1093799603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY BACHENBERG MD

Provider Business Mailing Address
First Line	:	800 MEDICAL CENTER DR
Second Line	:	PO BOX 800
City	:	FAIRMONT
State	:	MN
Zip	:	56031-4575
Country	:	US
Telephone Number	:	507-238-8555
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 MEDICAL CENTER DR
Second Line	:
City	:	FAIRMONT
State	:	MN
Zip	:	56031-4575
Country	:	US
Telephone Number	:	507-238-8555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	12/19/2013

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Directions to “ TIMOTHY BACHENBERG MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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