Allan P. Tidwell, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9107652 Issued in FL

Practice address

215 E Water St
Muncy, PA 17756-8828

Phone

(570) 321-2850

Fax

(570) 321-2851

NPI assigned

May 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Manatee Senior Care

  • Geriatric Medicine (Internal Medicine) Physician
  • Sarasota, FL
  • NPI 1316587926
  Medicare reassignment

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1801840566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 MANATEE AVE W",
            "address_2": "STE 101",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342058624",
            "telephone_number": "941-748-3065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 E WATER ST",
            "city": "MUNCY",
            "state": "PA",
            "postal_code": "177568828",
            "telephone_number": "570-321-2850",
            "fax_number": "570-321-2851"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Manatee Ave W Ste 101",
            "address_purpose": "LOCATION",
            "city": "Bradenton",
            "state": "FL",
            "postal_code": "342058624",
            "country_code": "US",
            "telephone_number": "941-748-3065",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "ALLAN",
        "middle_name": "P.",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9107652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susquehanna Physician Services
• Afrah Talpur, MD
• Mark Philip Tarquinio, BS PHARMACY
• Trudy L Temple
• The River Valley Regional Young Men'S Christian Association
• Townville Inc
• Peter B Trevouledes, M.D.
• Rose A. Trevouledes, MS., RD., LDN
• Tri-Town Modern Dental
• Whitney J Trump

• Physician Assistant in Muncy, PA
• Providers in Muncy, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.