Basic Information
| Provider Information | |||||||||
| NPI: | 1467430181 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORRIGAN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 217 20TH ST NW | ||||||||
| Address2: | PO BOX 857 | ||||||||
| City: | WAVERLY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 506772017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193529500 | ||||||||
| FaxNumber: | 3193529509 | ||||||||
| Practice Location | |||||||||
| Address1: | 217 20TH ST NW | ||||||||
| Address2: | |||||||||
| City: | WAVERLY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193529500 | ||||||||
| FaxNumber: | 3193529509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2006 | ||||||||
| LastUpdateDate: | 08/07/2018 | ||||||||
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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 | 28154 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 24265 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080150490 | 01 | IA | RR MEDICARE | OTHER | 8023283 | 05 | IA | MEDICAID |