TIMBERLAKE FAMILY MEDICINE (NPI# 1932392933) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932392933 |
| Entity Type | Organization |
| Organization Name | TIMBERLAKE FAMILY MEDICINE |
| Practice Address |
6101 E Highway 54 Ste A Athol ID 83801-8255 |
| Mailing Address |
Po Box 775 Athol ID 83801-0775 |
| Practice Telephone | 2086830800 |
| Practice Fax Number | 2086830900 |
| Mailing Telephone | 2086830800 |
| Mailing Fax Number | 2086830900 |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2007-08-22 |
| Authorized Official Name | MR. CHRISTOPHER RAY SUNDQUIST (OWNER) |
| Authorized Official Telephone | 2086830800 |
| Authorized Official Credential | PA-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
PA303 | ID | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BLUE CROSS | PAD92 | 01 | |
| REGENCE | 000010158675 | 01 |
| Street Address |
6101 E HIGHWAY 54 STE A |
| City | ATHOL |
| State | ID |
| Zip Code | 83801-8255 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578956637 | Country Clinical Massage | Massage Therapist | 6101 E Highway 54 Ste A, Athol, ID 83801-6085 | 2015-03-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366510752 | Christopher Ray Sundquist | Physician Assistant | 6101 W Hwy 54, Suite A, Athol, ID 83801 | 2006-12-01 |
| 1053496869 | Connie Jean Stone | Massage Therapist | 6115 E Hwy 54, Athol, ID 83801 | 2006-10-27 |
| 1659568871 | Carrie Valentine Blake | Midwife | 3155 Gwenn Ct, Athol, ID 83801-4909 | 2007-10-02 |
| 1952673204 | Donald K Merkeley | Pathology | 16301 E Bunco Rd, Athol, ID 83801-5048 | 2012-02-02 |
| 1366982316 | Davina Gelardi | Massage Therapist | 6101 E Highway 54, Athol, ID 83801-6085 | 2017-02-24 |
| 1629513940 | Kelly Sorensen | Lactation Consultant, Non-RN | 23582 Rapalla Ct, Athol, ID 83801-7002 | 2016-12-21 |
| 1720390347 | Charla-jo Olorenshaw Spradlin | Physical Therapist | 26453 N Old Highway 95, Athol, ID 83801-7076 | 2010-07-12 |
| 1174783724 | Tamara Marie Barnhart | Chiropractor | 6101 E Highway 54, Unit A, Athol, ID 83801-8255 | 2008-06-16 |
| 1861632028 | Natural Health Chiropractic LLC | Clinic/Center | 6101 E Highway 54, Unit A, Athol, ID 83801-8255 | 2009-03-02 |
| 1124253968 | Michele Renee Konechny | Massage Therapist | 24599 N Corbin Hill Rd, Athol, ID 83801-8304 | 2009-05-22 |
| Find all providers in zip 83801 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245313758 | Foley Family Practice, P.C. | Clinic/Center | 78 Brickyard Rd, Suite 2, Athol, MA 01331-2051 | 2006-10-20 |
| 1447205315 | Perpetual Health Clinic, Inc. | Clinic/Center | 1467 Main St, Suite 2, Athol, MA 01331-2652 | 2006-05-22 |
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|---|---|---|---|---|
| 1952923765 | Sterling Provider Group | Clinic/Center | 7017 Daisy Lane, Idaho Falls, ID 83402 | 2020-05-14 |
| 1457983462 | Amh Series II Id, LLC | Clinic/Center | 3875 E Overland Rd Ste 1e, Meridian, ID 83642-9005 | 2020-02-07 |
| 1306487517 | Northwest Integrated Health, LLP | Clinic/Center | 1250 West N. Northwood Center Ct, Suite B, Coeur D'alene, ID 83814 | 2019-09-30 |
| 1447801451 | Mountain Country Family Healthcare, Pllc | Clinic/Center | 31911 N 5th Ave, Spirit Lake, ID 83869 | 2019-09-23 |
| 1275186835 | Bella Family Healthcare & Aesthetics | Clinic/Center | 1545 E Leighfield Dr Ste 100, Meridian, ID 83646-5371 | 2019-07-22 |
| 1902387285 | Integrative Health Solutions Pllc | Clinic/Center | 1215 Michigan St Ste B, Sandpoint, ID 83864-5014 | 2018-08-24 |
| 1235618331 | Healthworks Med Group of Colorado P C | Clinic/Center | 126 E 21st St, Burley, ID 83318-2551 | 2018-08-09 |
| 1427537927 | Gem State Family Health Care Pllc | Clinic/Center | 496 Shoup Ave W Ste E, Twin Falls, ID 83301-5043 | 2018-08-07 |
| 1700379682 | Vera Whole Health, Wa PC | Clinic/Center | 219 Phil Meador Ave, Pocatello, ID 83202 | 2018-06-14 |
| 1073031118 | Clover Creek Medical | Clinic/Center | 175 North Main Street, Bloomington, ID 83223-8322 | 2017-09-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.