| Sally A Timmons Llc | |
|
120 Sagamore Parkway West West Lafayette IN 47906 | |
| (765) 404-6431 | |
| (765) 477-7843 |
| Full Name | Sally A Timmons Llc |
|---|---|
| Speciality | Social Worker |
| Location | 120 Sagamore Parkway West, West Lafayette, Indiana |
| Authorized Official Name and Position | Sally Ann Timmons (REGISTERED AGENT) |
| Authorized Official Contact | 7654046431 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sally A Timmons Llc 1805 Skyline Rd Lafayette IN 47905 Ph: (765) 404-6431 | Sally A Timmons Llc 120 Sagamore Parkway West West Lafayette IN 47906 Ph: (765) 404-6431 |
| NPI Number | 1871784330 |
|---|---|
| Provider Enumeration Date | 08/08/2007 |
| Last Update Date | 11/15/2007 |
| Medicare PECOS PAC ID | 3476574195 |
|---|---|
| Medicare Enrollment ID | O20051209000241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871784330 | NPI | - | NPPES |
| 000000375779 | Other | IN | ANTHEM BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 34004910A (Indiana) | Primary |
| Provider Name | Sally Ann Timmons |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114952397 PECOS PAC ID: 6103847827 Enrollment ID: I20051209000253 |
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