Provider Demographics
NPI:1073613014
Name:TIM SIEPEL MD P.C.
Entity Type:Organization
Organization Name:TIM SIEPEL MD P.C.
Other - Org Name:SERVICE MEDICAL P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:V
Authorized Official - Last Name:SIEPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-942-3219
Mailing Address - Street 1:8912 HEBDON RD
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14171-9741
Mailing Address - Country:US
Mailing Address - Phone:716-942-3219
Mailing Address - Fax:716-942-3977
Practice Address - Street 1:8912 HEBDON RD
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:14171-9741
Practice Address - Country:US
Practice Address - Phone:716-942-3219
Practice Address - Fax:716-942-3977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006266-64Medicaid
NYS070363Medicare ID - Type Unspecified
NY006266-64Medicaid