TIMBERLAKE FAMILY MEDICINE NPI 1932392933

NPI Information

NPI: 1932392933
Provider Name: TIMBERLAKE FAMILY MEDICINE
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
6101 E HIGHWAY 54 STE A
ATHOL, ID
ZIP 83801
Phone: (208) 683-0800
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TIMBERLAKE FAMILY MEDICINE is a primary care clinic center in Athol, ID. TIMBERLAKE FAMILY MEDICINE NPI is 1932392933. The provider is registered as an organization entity type.

The provider's business location address is:

6101 E HIGHWAY 54 STE A
ATHOL, ID
ZIP 83801-255
Phone: (208) 683-0800
Fax: (208) 683-0900

The provider's authorized official is Christopher Ray Sundquist .
The authorized official title is Owner and has the following contact phone number (208) 683-0800.

The enumeration date for this NPI number is 8/22/2007 and was last updated on 8/22/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	PA303	IDAHO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier Issuer
1	PAD92	OTHER	BLUE CROSS
2	P23313	MEDICARE UPIN
3	000010158675	OTHER	REGENCE
4	1665145	MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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