Individual
TIMOTHY COSGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1601 W 4TH ST, COFFEYVILLE, KS 67337-3333
(620) 251-8180
Mailing address
1601 W 4TH ST, COFFEYVILLE, KS 67337-3333
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4007
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200443500A
—
KS
01
—
6919005
MEDICARE PTAN
KS
Enumeration date
07/10/2007
Last updated
02/18/2013
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