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Timothy Adrian Connolly

Internal Medicine

Allopathic & Osteopathic Physicians

6560 Fannin St Ste 1632, Houston, TX 77030-2734

PECOS Enrollment

This provider is enrolled in PECOS as TIMOTHY CONNOLLY.

Based on the most recent information from CMS, provider Timothy Adrian Connolly is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 8:41 AM.

Profile Details

Provider ID
1396798153
Provider Type
Individual
Full Name
Connolly, Timothy Adrian
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
5/19/2006
Last Updated
11/2/2023

Contact Information

Practice Location

6560 Fannin St Ste 1632, Houston, TX 77030-2734

(713) 255-4000

(713) 255-4050

Mailing Location

Dept 794, Po Box 4346, Houston, TX 77210-4346

(713) 255-4000

(713) 255-4050

Provider Taxonomies

Code	Description	License
Code 207RP1001X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License L3267 Texas
Code 207RC0200X	Description Internal Medicine Allopathic & Osteopathic Physicians	License L3267 Texas
Code 207RS0012X	Description Internal Medicine Allopathic & Osteopathic Physicians	License L3267 Texas

Provider Identifiers

ID	Description	Issuer
ID 8R1145	Description Other	Issuer BLUE CROSS OF TEXAS PROV# Texas
ID P00316349	Description Other	Issuer RAILROAD MEDICARE NUMBER Texas

Timothy Adrian Connolly

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

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Description

License

Code

Description

License

Code

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License

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Provider Identifiers

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Description

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ID

Description

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