Active NPI
Timothy Wilburn, CPHT
- Other Technician
- Lenoir City, TN
National Provider Identifier
1730550567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 41357
- Practice address
- 721 Highway 321 N
Lenoir City, TN 37771-5003 - Phone
- (865) 988-0000
- Fax
- (865) 986-1542
- NPI assigned
- Oct 20, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 41357 | TN | Primary |
Addresses
Primary practice location
721 Highway 321 N
Lenoir City, TN 37771-5003
Mailing address
171 Cory Drive
Apt 324
Lenoir City, TN 37771-8577
Phone (423) 519-0117
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41357 | TN | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445299200000",
"number": "1730550567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "171 CORY DRIVE",
"address_2": "APT 324",
"city": "LENOIR CITY",
"state": "TN",
"postal_code": "377718577",
"telephone_number": "423-519-0117",
"fax_number": "865-986-1542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "721 HIGHWAY 321 N",
"city": "LENOIR CITY",
"state": "TN",
"postal_code": "377715003",
"telephone_number": "865-988-0000",
"fax_number": "865-986-1542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILBURN",
"first_name": "TIMOTHY",
"credential": "CPHT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-10-20",
"last_updated": "2015-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "TN",
"license": "41357",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lenoir City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.