Tim Mitchell Medical, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2004010987 Issued in MO

Legal business name

TIM MITCHELL MEDICAL, INC

Doing business as

Mitchell's Uptown Drug Store

Practice address

1504 N Business 49 Hwy
Neosho, MO 64850

Phone

(417) 451-9301

Fax

(417) 451-9307

NPI assigned

Sep 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael C Smith, R.PH.

Title

Manager

Phone

(417) 451-9301

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Mitchell's Uptown Drug Store Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Tim Mitchell Medical, Inc

  • Community/Retail Pharmacy
  • Neosho, MO
  • NPI 1184059784

  O20191204000110

  Same enrollment
• Tim Mitchell Medical, Inc

  • Community/Retail Pharmacy
  • Neosho, MO
  • NPI 1578669701

  O20191204000110

  Same enrollment

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Tim Mitchell Medical, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Neosho, MO
  • NPI 1952440422

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640736000000",
    "number": "1316041353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 N BUSINESS 49 HWY",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "64850",
            "telephone_number": "417-455-1883",
            "fax_number": "417-455-2781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 N BUSINESS 49 HWY",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "64850",
            "telephone_number": "417-451-9301",
            "fax_number": "417-451-9307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIM MITCHELL MEDICAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-11",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "417-451-9301",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2004010987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "626120505",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "606120509",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mitchell's Uptown Drug Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patricia Arlene Thompson, DC
• Tim Mitchell Medical Inc
• Tim Mitchell Medical Inc
• Tim Mitchell Medical Inc
• Tim Mitchell Medical, Inc
• Tim Mitchell Medical, Inc
• Tim Mitchell Medical, Inc
• Tim Mitchell Medical, Inc
• Tim Mitchell Medical, Inc.
• Shelby L Tinney-Edge, DO

• Community/Retail Pharmacy in Neosho, MO
• Providers in Neosho, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.