Timberlake Family Medicine | |
6101 E Highway 54 Ste A Athol ID 83801-8255 | |
(208) 683-0800 | |
(208) 683-0900 |
Full Name | Timberlake Family Medicine |
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Speciality | Clinic/center - Primary Care |
Location | 6101 E Highway 54 Ste A, Athol, Idaho |
Authorized Official Name and Position | Christopher Ray Sundquist (OWNER) |
Authorized Official Contact | 2086830800 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Timberlake Family Medicine Po Box 775 Athol ID 83801-0775 Ph: (208) 683-0800 | Timberlake Family Medicine 6101 E Highway 54 Ste A Athol ID 83801-8255 Ph: (208) 683-0800 |
NPI Number | 1932392933 |
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Provider Enumeration Date | 08/22/2007 |
Last Update Date | 08/22/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1932392933 | NPI | - | NPPES |
PAD92 | Other | BLUE CROSS | |
000010158675 | Other | REGENCE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | PA303 (Idaho) | Primary |