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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
Organization: CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION

PECOS Registration: Yes

Address:
3415 W HORIZON AVE
SPOKANE, WA
ZIP 99208
Phone: (509) 220-1900
Get Directions

Timothy Bock Icenogle, MD is a thoracic surgery cardiothoracic vascular surgery in Spokane, WA with 45 years of experience. 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.

Education
Medical School: UNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE
Graduation Year:1979

The provider's business location address is:

3415 W HORIZON AVE
SPOKANE, WA
ZIP 99208-493
Phone: (509) 220-1900

The NPI 1285683029 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/9/2006 and was last updated on 5/10/2021.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1204F00000XTransplant SurgeryMD00026659WASHINGTONNo
2208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery)S9004TEXASNo
3208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery)MD00026659WASHINGTONYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther 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: 11/14/2023

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.