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1184630212

NPI Code Detail

MEDICARE: DR. EDWARD TIMOTHY OKELLEY MD

MEDICARE: DR. EDWARD TIMOTHY OKELLEY 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	G3658	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	010017871	OTHER		MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A007	OTHER		CHAMPUS
3	806058	OTHER	TX	BCBS
4	118097	OTHER		CHIPS
5	97279	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1184630212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD TIMOTHY OKELLEY MD

Provider Business Mailing Address
First Line	:	PO BOX 1326
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75671-1326
Country	:	US
Telephone Number	:	903-927-3782
Fax Number	:	903-927-1764

Provider Business Practice Location Address
First Line	:	1011 SOUTH WILLIAM
Second Line	:
City	:	ATLANTA
State	:	TX
Zip	:	75551-3245
Country	:	US
Telephone Number	:	903-796-2868
Fax Number	:	903-796-0826

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	08/28/2023

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Directions to “ DR. EDWARD TIMOTHY OKELLEY 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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