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NPI Code Detail

MEDICARE: TIMOTHY J. JOVICK PHD

MEDICARE: TIMOTHY J. JOVICK PHD
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
1103TC0700XClinical PsychologistPRY0037MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1135668OTHERMOCOMPSYCH
2093726OTHERMOMAGELLAN
3115260OTHERBCBS
4887579OTHERMOFIRST HEALTH
5077439OTHERMOVALUE OPTIONS

General Provider Information

NPI Number : 1174620793
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY J. JOVICK PHD
Provider Business Mailing Address
First Line : 8772 BIG BEND BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63119-3730
Country : US
Telephone Number : 314-962-7788
Fax Number : 314-962-4158
Provider Business Practice Location Address
First Line : 8772 BIG BEND BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63119-3730
Country : US
Telephone Number : 314-962-7788
Fax Number : 314-962-4158
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2006
Last Update Date : 07/08/2007

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Directions to “ TIMOTHY J. JOVICK PHD” Practice Location

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