Provider Demographics
NPI:1497226286
Name:TIMMS, WENDELL KEITH
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:KEITH
Last Name:TIMMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20403 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23803-1647
Mailing Address - Country:US
Mailing Address - Phone:804-536-2266
Mailing Address - Fax:
Practice Address - Street 1:5009 SPRUCEWOOD AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-4274
Practice Address - Country:US
Practice Address - Phone:804-536-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)