Provider Demographics
NPI:1144464249
Name:YORK, TIMOTHY MICHEAL (LSA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MICHEAL
Last Name:YORK
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73024
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77273-3024
Mailing Address - Country:US
Mailing Address - Phone:832-264-1953
Mailing Address - Fax:281-288-6617
Practice Address - Street 1:111 VISION PARK BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3002
Practice Address - Country:US
Practice Address - Phone:832-264-1953
Practice Address - Fax:281-288-6617
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00411246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX246ZC0007XOtherSURGICAL ASSISTANT