Provider Demographics
NPI:1619975240
Name:HUME, TIMOTHY DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DALE
Last Name:HUME
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:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-864-1472
Mailing Address - Fax:270-858-4607
Practice Address - Street 1:1515 EDMONTON RD
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-9402
Practice Address - Country:US
Practice Address - Phone:270-487-9272
Practice Address - Fax:270-487-6242
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN99346Medicaid
KYANTHEMOther000000049273
KY64238926Medicaid
KYANTHEMOther000000049273
TN99346Medicaid