Provider Demographics
NPI:1427064799
Name:CALLAHAN, TIMOTHY ADAM (PAC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ADAM
Last Name:CALLAHAN
Suffix:
Gender:
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:EAST CARBON
Mailing Address - State:UT
Mailing Address - Zip Code:84520-0930
Mailing Address - Country:US
Mailing Address - Phone:435-888-4411
Mailing Address - Fax:435-888-2270
Practice Address - Street 1:331 E HIGHWAY 123
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:UT
Practice Address - Zip Code:84539-7725
Practice Address - Country:US
Practice Address - Phone:435-888-4411
Practice Address - Fax:435-888-2270
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT314106-8906363AM0700X
UT314106-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00228226OtherRAILROAD MEDICARE
UTD20135Medicare UPIN
UT005751001Medicare ID - Type Unspecified