Basic Information
| Provider Information | |||||||||
| NPI: | 1740678887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EIKOM | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | GLENN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5448 MIDWINTER MIST ST | ||||||||
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| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890317937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609530739 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 N US HIGHWAY 89 | ||||||||
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| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863135001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284454860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2014 | ||||||||
| LastUpdateDate: | 12/23/2014 | ||||||||
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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 | 246RM2200X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Medical Laboratory |
No ID Information.