Basic Information
| Provider Information | |||||||||
| NPI: | 1083707855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THYMIUS | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 HARPER RD | ||||||||
| Address2: | THIRD FLOOR SUITE E | ||||||||
| City: | BECKLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258013373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042543131 | ||||||||
| FaxNumber: | 3042543037 | ||||||||
| Practice Location | |||||||||
| Address1: | 1717 HARPER RD | ||||||||
| Address2: | 3RD FLOOR SUTIE E | ||||||||
| City: | BECKLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258013373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042543131 | ||||||||
| FaxNumber: | 3042543037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 10/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1729 | WV | N | Allopathic & Osteopathic Physicians | Family Medicine | 208VP0014X | 1729 | WV | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 74593 | 05 | WV | MEDICAID | 001722250 | 01 | BCBS | OTHER | 58067 | 05 | WV | MEDICAID | 319155 | 01 | CARELINK | OTHER | 5600400000 | 05 | WV | MEDICAID |