| Tim Thistlethwaite, M.d. Pllc | |
|
100 Peyton Way Suite 100 Charleston WV 25309-8767 | |
| (304) 205-5207 | |
| (304) 205-5318 |
| Full Name | Tim Thistlethwaite, M.d. Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 100 Peyton Way, Charleston, West Virginia |
| Authorized Official Name and Position | Tim L Thistlethwaite (OWNER) |
| Authorized Official Contact | 3042055207 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tim Thistlethwaite, M.d. Pllc 100 Peyton Way Suite 100 Charleston WV 25309-8767 Ph: (304) 205-5207 | Tim Thistlethwaite, M.d. Pllc 100 Peyton Way Suite 100 Charleston WV 25309-8767 Ph: (304) 205-5207 |
| NPI Number | 1386738508 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 10/04/2013 |
| Medicare PECOS PAC ID | 8426056565 |
|---|---|
| Medicare Enrollment ID | O20061128000023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386738508 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 1225 (West Virginia) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 17498 (West Virginia) | Primary |
| Provider Name | Timothy L Thistlethwaite |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831284116 PECOS PAC ID: 2860499852 Enrollment ID: I20061106000170 |
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