1225078157 NPI number — MR. TIMOTHY J ZIOLKOWSKI MD

Table of content: MR. TIMOTHY J ZIOLKOWSKI MD (NPI 1225078157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225078157 NPI number — MR. TIMOTHY J ZIOLKOWSKI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIOLKOWSKI
Provider First Name:
TIMOTHY
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225078157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5454 NEW CUT RD
Provider Second Line Business Mailing Address:
STE 5
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-361-9900
Provider Business Mailing Address Fax Number:
502-361-9947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 ABRAHAM FLEXNOR WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-361-9900
Provider Business Practice Location Address Fax Number:
502-361-9947
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  39137 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207PE0004X , with the licence number: 27164 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000057678 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64104565 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50010463 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 610893149001 . This is a "TRICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00320032 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200818370 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2711345000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 610893149 . This is a "HUMANA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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