Basic Information
| Provider Information | |||||||||
| NPI: | 1336519891 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TIMOTHY E. SNELL, MD, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4107 | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832054107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082327760 | ||||||||
| FaxNumber: | 2082321950 | ||||||||
| Practice Location | |||||||||
| Address1: | 2240 E CENTER ST | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832012600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082333613 | ||||||||
| FaxNumber: | 2082336983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2015 | ||||||||
| LastUpdateDate: | 09/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | GILBERT | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2082327760 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CPC, CPMA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | M-12503 | ID | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.