Provider Demographics
NPI:1376677070
Name:TIMOTHY M. FISHER, D.O., P.C.
Entity type:Organization
Organization Name:TIMOTHY M. FISHER, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:931-473-4441
Mailing Address - Street 1:140 VO TECH DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1329
Mailing Address - Country:US
Mailing Address - Phone:931-473-4441
Mailing Address - Fax:931-473-5031
Practice Address - Street 1:140 VO TECH DR
Practice Address - Street 2:SUITE 6
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1329
Practice Address - Country:US
Practice Address - Phone:931-473-4441
Practice Address - Fax:931-473-5031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000000851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3374306Medicaid
TN3374306Medicaid
TN3374306Medicare ID - Type Unspecified
TN3374306Medicaid