| Timberlake Family Medicine | |
|
6101 E Highway 54 Ste A Athol ID 83801-8255 | |
| (208) 683-0800 | |
| (208) 683-0900 |
| Full Name | Timberlake Family Medicine |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| 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 |