1265527246 NPI number — TIMBERLINE PHYSICIANS, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265527246 NPI number — TIMBERLINE PHYSICIANS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIMBERLINE PHYSICIANS, P.C.
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:
6
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:
1265527246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4677 TOWNE CENTRE RD
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48604-2846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-793-7220
Provider Business Mailing Address Fax Number:
989-793-7482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 S. WASHINGTON AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-907-8200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NIELSEN
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
989-793-7220

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0N85370 . This is a "MEDICARE GROUP IDENTIFIER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0G36084 . This is a "MEDICARE ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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