Provider Demographics
NPI:1952440422
Name:TIM MITCHELL MEDICAL, INC.
Entity Type:Organization
Organization Name:TIM MITCHELL MEDICAL, INC.
Other - Org Name:FAMILY PHARMACY OF NEOSHO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-451-9501
Mailing Address - Street 1:1009 S NEOSHO BLVD
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-2008
Mailing Address - Country:US
Mailing Address - Phone:417-455-1883
Mailing Address - Fax:417-455-1889
Practice Address - Street 1:1000 S NEOSHO BLVD
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-2007
Practice Address - Country:US
Practice Address - Phone:417-451-9501
Practice Address - Fax:417-451-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4963630001Medicare NSC