Provider Demographics
NPI:1548227382
Name:NEWCOMB, TIMOTHY P (CRNA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:NEWCOMB
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DEXTER CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3461
Mailing Address - Country:US
Mailing Address - Phone:563-344-6600
Mailing Address - Fax:563-344-6699
Practice Address - Street 1:3400 DEXTER CT
Practice Address - Street 2:SUITE 101
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3461
Practice Address - Country:US
Practice Address - Phone:563-344-6600
Practice Address - Fax:563-344-6699
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD-094792367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA0120OtherJOHN DEERE HEALTHPLAN
IA0435800Medicaid
IA16166OtherBLUECROSS BLUE SHIELD
IAP00232878OtherRAILROAD MEDICARE
IA16166OtherBLUECROSS BLUE SHIELD
IAIA0120OtherJOHN DEERE HEALTHPLAN