Provider Demographics
NPI:1083707855
Name:THYMIUS, ANDREW C (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
Last Name:THYMIUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 HARPER RD
Mailing Address - Street 2:THIRD FLOOR SUITE E
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3373
Mailing Address - Country:US
Mailing Address - Phone:304-254-3131
Mailing Address - Fax:304-254-3037
Practice Address - Street 1:1717 HARPER RD
Practice Address - Street 2:3RD FLOOR SUTIE E
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3373
Practice Address - Country:US
Practice Address - Phone:304-254-3131
Practice Address - Fax:304-254-3037
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1729207Q00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV74593Medicaid
001722250OtherBCBS
WV58067Medicaid
319155OtherCARELINK
WV5600400000Medicaid
WV58067Medicaid
001722250OtherBCBS
WVTH2026491Medicare ID - Type Unspecified
WVH10126Medicare ID - Type UnspecifiedUGS MEDICARE
WV74593Medicaid