1861618191 NPI number — TIMBERLINE CLINIC, INC.

Table of content: OLIVIER NICOLAS KOCHER M.D. (NPI 1669586566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861618191 NPI number — TIMBERLINE CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIMBERLINE CLINIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861618191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 723
Provider Second Line Business Mailing Address:
980 MAIN ST.
Provider Business Mailing Address City Name:
FAIRPLAY
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80440-0723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-836-3455
Provider Business Mailing Address Fax Number:
719-836-1792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
980 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRPLAY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80440-0723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-836-3455
Provider Business Practice Location Address Fax Number:
719-836-1792
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
719-836-3455

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  43262 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01 . This is a "CO PACIFICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 500000326 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: SH29090 . This is a "CO BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 04008850 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07100753 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: YO634320 . This is a "CO BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 01219609 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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