Basic Information
| Provider Information | |||||||||
| NPI: | 1679543623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHWOB | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1019 W OAKLAND AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376042357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239155000 | ||||||||
| FaxNumber: | 4239155045 | ||||||||
| Practice Location | |||||||||
| Address1: | 1019 W OAKLAND AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239155000 | ||||||||
| FaxNumber: | 4239155045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 06/04/2018 | ||||||||
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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 | 0101038397 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 16907 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | Q003433 | 05 | RI | MEDICAID | 1679543623 | 05 | VA | MEDICAID | P00985989 | 01 | VA | RR MEDICARE | OTHER | 080188264 | 01 | TN | RR MEDICARE | OTHER |