Provider Demographics
NPI:1285726844
Name:THYMIUS, TIFFANY K (DO)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:K
Last Name:THYMIUS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:KITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:252 RURAL ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3503
Mailing Address - Country:US
Mailing Address - Phone:304-252-8551
Mailing Address - Fax:304-252-1790
Practice Address - Street 1:252 RURAL ACRES DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3503
Practice Address - Country:US
Practice Address - Phone:304-252-8551
Practice Address - Fax:304-252-1790
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00389007OtherMEDICARE TRAVELERS RAILRO
WV90036Medicaid
321726OtherCARELINK
WV1806250000Medicaid
WV58588Medicaid
H54912OtherHEALTH NET
H54912Medicare UPIN
WVTH2026541Medicare ID - Type Unspecified
WV58588Medicaid