Provider Demographics
NPI:1073273991
Name:TIMECERTIAN W, PC
Entity Type:Organization
Organization Name:TIMECERTIAN W, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KNEPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-925-2200
Mailing Address - Street 1:1950 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2035
Mailing Address - Country:US
Mailing Address - Phone:317-925-2200
Mailing Address - Fax:
Practice Address - Street 1:1055 S HUNT ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-9702
Practice Address - Country:US
Practice Address - Phone:317-925-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty