Timothy W McIntyre, MD
Individual provider Active NPI Family Medicine Physician · Bridgeport, TX
NPI 1366447088 · NPPES record last updated Jul 20, 2021
Key facts
- NPI
- 1366447088
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- H7635 (TX)
- Practice address
- 411 N Lake Shore Cir
Bridgeport, TX 76426-4467 - Phone
- (940) 210-8275
- NPI assigned
- Jun 17, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040609000905 | TX | Practitioner - Family Practice |
1658354857 |
Reassigns benefits to 3 organizations Practice locations: Boyd, TX |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H7635 | TX | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fisher County Hospital District | Current |
Accepting new patients | |
| Fisher County Hospital District | Emergency Medicine | Current |
Accepting new patients |
| Concord Medical Group of Texas PLLC | Emergency Medicine | Current |
Accepting new patients |
| Fisher County Hospital District | Current | Accepting new patients | |
| Concord Medical Group PLLC | Emergency Medicine | Current |
Accepting new patients |
| Boyd Medical Clinic | Family Medicine | Past |
Accepting new patients |
Locations
1601 W 11th Pl
Big Spring, TX 79720
Phone (432) 263-1211
200 S Geneva St
Breckenridge, TX 76424
Phone (254) 559-2241
310 W South St
Henrietta, TX 76365
Phone (806) 647-2191
215 Chisholm Trl
Jacksboro, TX 76458
Phone (940) 567-5528
774 State Highway 70 N
Rotan, TX 79546
Phone (325) 735-2256
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | H7635 | TX | Yes |
| Emergency Medicine Physician | 207P00000X | H7635 | TX |
Addresses
Primary practice location
411 N Lake Shore Cir
Bridgeport, TX 76426-4467
Mailing address
PO Box 211
Bridgeport, TX 76426-0211
Phone (940) 210-8275
Other practice location 1
308 W Rock Island Rd
Boyd, TX 76023-3106
Phone (940) 433-5122
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 137267405 | Medicaid | TX | |
| 137267410 | Medicaid | TX | |
| 010057154 | Other | TX | RAILROAD MEDICARE |
| 137267401 | Medicaid | TX |
Other providers in Bridgeport, TX
- Longbines Pharmacy Inc
- Longbines Pharmacy Inc
- Mauldin Pharmacy Inc
- Charles L Mauldin
- Jacob Mayberry
- Christine Rene Meredith
- Noemi Araceli Meza
- Michael a. Basco M.D. PA
- Whitney Victoria Miller
- Michael A Millis
All providers in Bridgeport, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.