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TIMOTHY BOCK ICENOGLE MD
NPI 1285683029
Thoracic Surgery (Cardiothoracic Vascular Surgery) in Ogden, UT

Active since May 09, 2006
4403 HARRISON BLVD STE 3835, OGDEN, UT 84403(801) 387-3475(801) 387-3480 Get Directions Write a Review

NPPES record last updated: December 13, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 13, 2022, May 10, 2021, May 4, 2021 and 1 more (4 updates tracked since 2016).

About Timothy Bock Icenogle Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TIMOTHY BOCK ICENOGLE MD (NPI 1285683029) is an individual thoracic surgery (cardiothoracic vascular surgery) provider in Ogden, Utah, licensed in Utah (126770044-1205) and active in the NPI registry since May 2006. He maintains 2 additional practice locations.

NPPES Registry Identity

NPI1285683029
Entity TypeIndividualMale
Primary Taxonomy208G00000X
Provider Legal NameTIMOTHY BOCK ICENOGLECredential: MD
Location Address4403 HARRISON BLVD STE 3835Ogden, UT 84403-3331
Mailing AddressPo Box 27128Salt Lake City, UT 84127-0128
Phone(801) 387-3475
Fax(801) 387-3480
Sole ProprietorNo
Enumeration DateMay 9, 2006
Last NPPES UpdateDecember 13, 20224 updates tracked since enumeration
NPPES CertifiedDecember 13, 2022
✔ NPI 1285683029 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyThoracic Surgery (Cardiothoracic Vascular Surgery)Allopathic & Osteopathic Physicians
Taxonomy Code208G00000X
Licenses✔ Licensed in UT · 126770044-1205✔ Licensed in TX · S9004✔ Licensed in WA · MD00026659
Definition
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.
Also ListedTransplant SurgeryTaxonomy 204F00000X · License MD00026659 (WA)
4403 HARRISON BLVD STE 3835, Ogden, UT 84403
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Secondary Practice Locations 2

Location 13415 W Horizon AveSpokane, WA 99208-8493 · Phone (509) 220-1900
Location 2100 Hillcrest Medical BlvdWaco, TX 76712-8897 · Phone (254) 202-2000 · Fax (254) 202-5849

Other Identifiers 3

Medicaid1072495WA
Medicaid3756900ID
Medicaid3505645MT

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, Providence Health Plan.Insurance ›

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DEVIN ROBERT RIGG MD
Thoracic Surgery (Cardiothoracic Vascular Surgery)
4403 HARRISON BLVD STE 3835
OGDEN, UT 84403
Weber County (801) 387-3475

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Timothy Icenogle's NPI number?

The NPI number for Timothy Icenogle is 1285683029. It was assigned to this individual provider in the NPPES registry on May 9, 2006.

Where is Timothy Icenogle located?

Timothy Icenogle practices at 4403 Harrison Blvd Ste 3835, Ogden, UT 84403. The listed phone number is (801) 387-3475.

What is Timothy Icenogle's specialty?

The primary specialty registered for this NPI is Thoracic Surgery (Cardiothoracic Vascular Surgery) with taxonomy code 208G00000X.

What insurance does Timothy Icenogle accept?

Health plans from Blue Cross and Blue Shield of Texas and Providence Health Plan list Timothy Icenogle as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Timothy Icenogle was last updated on December 13, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.