| Tima Wellness Pa | |
|
1591 Yanceyville Street Suite 200a Greensboro NC 27405-6941 | |
| (336) 907-3006 | |
| (336) 663-8421 |
| Full Name | Tima Wellness Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 1591 Yanceyville Street, Greensboro, North Carolina |
| Authorized Official Name and Position | Byron Gladden (PRACTICE MANAGER) |
| Authorized Official Contact | 3369073006 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tima Wellness Pa 1591 Yanceyville Street Suite 200a Greensboro NC 27405-6941 Ph: (336) 907-3006 | Tima Wellness Pa 1591 Yanceyville Street Suite 200a Greensboro NC 27405-6941 Ph: (336) 907-3006 |
| NPI Number | 1609260942 |
|---|---|
| Provider Enumeration Date | 03/25/2015 |
| Last Update Date | 11/30/2017 |
| Medicare PECOS PAC ID | 8527371574 |
|---|---|
| Medicare Enrollment ID | O20150720001741 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609260942 | NPI | - | NPPES |
| 8975633 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 95-01417 (North Carolina) | Primary |
| Provider Name | Kimberly R Shelton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649270984 PECOS PAC ID: 9133102403 Enrollment ID: I20071126000141 |
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