Timothy Cosgrove
Individual provider Active NPI Clinical Social Worker · Coffeyville, KS
NPI 1194923201 · NPPES record last updated Feb 18, 2013
Key facts
- NPI
- 1194923201
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 4007 (KS)
- Practice address
- 1601 W 4TH St
Coffeyville, KS 67337-3333 - Phone
- (620) 251-8180
- NPI assigned
- Jul 10, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4007 | KS | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Four County Mental Health Center Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4007 | KS | Yes |
Addresses
Primary practice location
1601 W 4TH St
Coffeyville, KS 67337-3333
Mailing address
1601 W 4TH St
Coffeyville, KS 67337-3333
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6919005 | Other | KS | MEDICARE PTAN |
| 200443500A | Medicaid | KS |
Other providers in Coffeyville, KS
- Community Health Center of Southeast Kansas Inc
- Community Health Center of Southeast Kansas, Inc
- Community Health Center of Southeast Kansas, Inc.
- Jon W. Conrad
- Alan Duane Conrady
- County of Montgomery
- Cynthia Marie Dale
- Tina Daniel
- David C. Bumgarner, D.C., P.a.
- Antwanette Davis
All providers in Coffeyville, KS · Clinical Social Worker in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.