Basic Information
Provider Information | |||||||||
NPI: | 1487813168 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TINCHER | ||||||||
FirstName: | STEVEN | ||||||||
MiddleName: | WAYNE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 850489 | ||||||||
Address2: |   | ||||||||
City: | MOBILE | ||||||||
State: | AL | ||||||||
PostalCode: | 366850489 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2513423949 | ||||||||
FaxNumber: | 2516313361 | ||||||||
Practice Location | |||||||||
Address1: | 731 S PEAR ORCHARD ROAD | ||||||||
Address2: | SUITE 16 | ||||||||
City: | RIDGELAND | ||||||||
State: | MS | ||||||||
PostalCode: | 39157 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6013265330 | ||||||||
FaxNumber: | 6013265356 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/06/2008 | ||||||||
LastUpdateDate: | 06/05/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 29774 | AL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 20976 | MS | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | 9139825 | 01 | MS | AETNA | OTHER | 08979820 | 05 | MS |   | MEDICAID | 2862865 | 01 | MS | CIGNA | OTHER | 6052556 | 01 | MS | HEALTHSPRING | OTHER |