Provider Demographics
NPI:1992841233
Name:CHARLES H. WILKENS, M.D.,P.C.
Entity type:Organization
Organization Name:CHARLES H. WILKENS, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPC
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-784-0269
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-0447
Mailing Address - Country:US
Mailing Address - Phone:423-784-7269
Mailing Address - Fax:
Practice Address - Street 1:131 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-4404
Practice Address - Country:US
Practice Address - Phone:423-784-7269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001320Medicaid
TN3378081Medicare PIN
KY35001320Medicaid