| Tim Mcnicoll Md Inc | |
|
2876 Sycamore Dr Suite 101 Simi Valley CA 93065-1530 | |
| (805) 527-6424 | |
| (805) 522-0115 |
| Full Name | Tim Mcnicoll Md Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2876 Sycamore Dr, Simi Valley, California |
| Authorized Official Name and Position | Timothy J Mcnicoll (PRESIDENT/OWNER) |
| Authorized Official Contact | 8055276424 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tim Mcnicoll Md Inc 2876 Sycamore Dr Suite 101 Simi Valley CA 93065-1530 Ph: (805) 527-6424 | Tim Mcnicoll Md Inc 2876 Sycamore Dr Suite 101 Simi Valley CA 93065-1530 Ph: (805) 527-6424 |
| NPI Number | 1144475864 |
|---|---|
| Provider Enumeration Date | 11/21/2008 |
| Last Update Date | 02/03/2009 |
| Medicare PECOS PAC ID | 1658434634 |
|---|---|
| Medicare Enrollment ID | O20090117000035 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144475864 | NPI | - | NPPES |
| 00G481000 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G48100 (California) | Primary |
| Provider Name | Timothy J Mcnicoll |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1790750115 PECOS PAC ID: 8325052293 Enrollment ID: I20060130000923 |
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