Basic Information
| Provider Information | |||||||||
| NPI: | 1124037395 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIENS | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671148778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162845170 | ||||||||
| FaxNumber: | 3162831333 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671148778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162836103 | ||||||||
| FaxNumber: | 3162831333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2006 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21488 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100115410B | 05 | KS | MEDICAID | 16875 | 01 | KS | COVENTRY | OTHER | 100408 | 01 | KS | HPK | OTHER | 024974 | 01 | KS | BCBS | OTHER | 1017 | 01 | KS | PHS | OTHER | 12149419 | 01 | KS | MULTIPLAN | OTHER |