Provider Demographics
NPI:1245005735
Name:RUDMANN, TIMOTHY ANDREW
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ANDREW
Last Name:RUDMANN
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 1:2901 PIGEON ROOST RD
Mailing Address - Street 2:
Mailing Address - City:RUSH
Mailing Address - State:KY
Mailing Address - Zip Code:41168-8132
Mailing Address - Country:US
Mailing Address - Phone:606-928-6648
Mailing Address - Fax:606-928-1056
Practice Address - Street 1:835 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7423
Practice Address - Country:US
Practice Address - Phone:606-547-4400
Practice Address - Fax:606-547-4180
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator