Edmisten, Timothy Dwight
Edmisten, Timothy Dwight is an sole proprietor health care provider with primary practice located at 965 State Farm Rd , Boone NC 28607-4948. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Vascular Surgery, Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery), Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Edmisten, Timothy Dwight can be contacted via phone (828) 264-2340.Contact Information
Primary practice address
965 State Farm Rd
Boone NC 28607-4948
Phone: (828) 264-2340
Fax: (828) 262-0731
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Vascular Surgery | 2086S0129X | 9800856 | North Carolina |
| Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 9800856 | North Carolina |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 9800856 | North Carolina |
Profile Details
| NPI number | 1780679357 |
|---|---|
| LBN Legal business name | Edmisten, Timothy Dwight |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 20th, 2005 |
| Last updated | Mar 10th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780679357 | NPPES |
| North Carolina | MEDICAID | 891227R |
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