Provider Demographics
NPI:1023012507
Name:QUIGLEY, TIMOTHY F (PA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:F
Last Name:QUIGLEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 782830
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67278-2830
Mailing Address - Country:US
Mailing Address - Phone:316-686-6303
Mailing Address - Fax:316-686-6764
Practice Address - Street 1:9415 E HARRY ST
Practice Address - Street 2:STE 800
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5084
Practice Address - Country:US
Practice Address - Phone:316-686-6303
Practice Address - Fax:316-686-6764
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00421363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
548487Medicare UPIN
KS042178Medicare ID - Type Unspecified