Provider Demographics
NPI:1710377445
Name:TWC EMERGENCY PHYSICIANS, INC.
Entity type:Organization
Organization Name:TWC EMERGENCY PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMERGENCY PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALICOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-920-8556
Mailing Address - Street 1:14623 CHAMBERY DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-5586
Mailing Address - Country:US
Mailing Address - Phone:501-920-8556
Mailing Address - Fax:
Practice Address - Street 1:14623 CHAMBERY DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-5586
Practice Address - Country:US
Practice Address - Phone:501-920-8556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-8421282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR126098001Medicaid
AR5J486IMedicare UPIN