MEDICARE: DR. TIMOTHY JOSEPH QUILLEN M.D.

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	208800000X	Urology Physician	14869	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00360562	OTHER	SC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	774449	OTHER	SC	WELLCARE
2	80023042	OTHER	SC	SELECT HEALTH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619922879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY JOSEPH QUILLEN M.D.

Provider Business Mailing Address
First Line	:	135 PROFESSIONAL PARK DR
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-9261
Country	:	US
Telephone Number	:	843-347-8765
Fax Number	:	843-236-4746

Provider Business Practice Location Address
First Line	:	135 PROFESSIONAL PARK DR
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-9261
Country	:	US
Telephone Number	:	843-347-8765
Fax Number	:	843-236-4746

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	04/30/2026

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Directions to “ DR. TIMOTHY JOSEPH QUILLEN M.D.” Practice Location

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