Provider Demographics
NPI:1740464908
Name:TIMOTHY HORSKY
Entity type:Organization
Organization Name:TIMOTHY HORSKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HORSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:931-752-7851
Mailing Address - Street 1:PO BOX 932
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-0932
Mailing Address - Country:US
Mailing Address - Phone:931-752-7851
Mailing Address - Fax:931-752-7853
Practice Address - Street 1:200 DUNCAN STREET
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556
Practice Address - Country:US
Practice Address - Phone:931-752-7851
Practice Address - Fax:931-752-7853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1552208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPENDINGMedicaid
TNG87358Medicare UPIN
TNPENDINGMedicaid