Basic Information
| Provider Information | |||||||||
| NPI: | 1891743498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIMMONS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 CAMPUS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405365100 | ||||||||
| FaxNumber: | 5405360235 | ||||||||
| Practice Location | |||||||||
| Address1: | 13737 SPOTSWOOD TRL | ||||||||
| Address2: | |||||||||
| City: | ELKTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228273200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5402981200 | ||||||||
| FaxNumber: | 5402981144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 03/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101043469 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5615861 | 05 | VA | MEDICAID | 080080292 | 01 | RAILROAD MEDICARE | OTHER | 08107000000 | 01 | SOUTHERN HEALTH | OTHER | 1000870001 | 01 | VA | DME PROVIDER | OTHER | 22579 | 01 | VA | OPTIMA | OTHER | 106059 | 01 | ANTHEM/BCBS | OTHER | 700103083 | 01 | CIGNA | OTHER |