Provider Demographics
NPI:1780981498
Name:TIM WILKIN D.O., P.A.
Entity type:Organization
Organization Name:TIM WILKIN D.O., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:870-247-8900
Mailing Address - Street 1:8608 DOLLARWAY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-2814
Mailing Address - Country:US
Mailing Address - Phone:870-247-8900
Mailing Address - Fax:870-247-8903
Practice Address - Street 1:8608 DOLLARWAY RD
Practice Address - Street 2:SUITE C
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-2814
Practice Address - Country:US
Practice Address - Phone:870-247-8900
Practice Address - Fax:870-247-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5K460OtherBLUE CROSS BLUE SHIELD/MEDICARE
AR131533003Medicaid
AR131533003Medicaid