Provider Demographics
NPI:1083692982
Name:MIMS, TIMOTHY T (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:T
Last Name:MIMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7145 E VIRGINIA ST STE 2000
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-9147
Mailing Address - Country:US
Mailing Address - Phone:812-962-7890
Mailing Address - Fax:812-476-6162
Practice Address - Street 1:2443 SIR BARTON WAY STE 275
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509
Practice Address - Country:US
Practice Address - Phone:812-962-7890
Practice Address - Fax:812-476-6162
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231723207LP2900X
KY48908207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02566392Medicaid
KY7100428760Medicaid
KY7100428760Medicaid
NY02566392Medicaid
KYK199750Medicare PIN
NY06143JMedicare PIN