TIMOTHY BOCK ICENOGLE MD NPI 1285683029

NPI Information

  • NPI: 1285683029
  • Provider Name: TIMOTHY BOCK ICENOGLE, MD
  • Classification: Thoracic Surgery (Cardiothoracic Vascular Surgery) - 208G00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4403 HARRISON BLVD STE 3835
    OGDEN, UT
    ZIP 84403
  • Phone: (801) 387-3475

Map and Directions

Get Directions

NPI Details

Timothy Bock Icenogle, MD is a thoracic surgery cardiothoracic vascular surgery in Ogden, UT. The provider is a thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. Timothy Bock Icenogle, MD NPI is 1285683029. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4403 HARRISON BLVD STE 3835
OGDEN, UT
ZIP 84403-331
Phone: (801) 387-3475
Fax: (801) 387-3480

The NPI 1285683029 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 5/9/2006 and was last updated on 12/13/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1204F00000XTransplant SurgeryMD00026659WASHINGTONNo
2208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery)S9004TEXASNo
3208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery)MD00026659WASHINGTONNo
4208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery)126770044-1205UTAHYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11072495MEDICAIDWASHINGTON
23756900MEDICAIDIDAHO
33505645MEDICAIDMONTANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI