Provider Demographics
NPI:1174712939
Name:TIMOTHY J PIRNAT M.D. INC
Entity type:Organization
Organization Name:TIMOTHY J PIRNAT M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:PIRNAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-383-2238
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45135-0347
Mailing Address - Country:US
Mailing Address - Phone:937-218-6635
Mailing Address - Fax:888-422-2159
Practice Address - Street 1:12980 SABINA RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:OH
Practice Address - Zip Code:45135-9578
Practice Address - Country:US
Practice Address - Phone:937-218-6635
Practice Address - Fax:888-422-2159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-9586173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3109773Medicaid
OHCK4485Medicare PIN
OH3109773Medicaid