Provider Demographics
NPI:1063834091
Name:TIMBERLAND MEDICAL GROUP
Entity Type:Organization
Organization Name:TIMBERLAND MEDICAL GROUP
Other - Org Name:MEDICAL PLAZA IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-628-6038
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:830-769-4000
Mailing Address - Fax:830-769-5248
Practice Address - Street 1:1907 HIGHWAY 97 E
Practice Address - Street 2:SUITE 250
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-1538
Practice Address - Country:US
Practice Address - Phone:830-769-4000
Practice Address - Fax:730-769-5248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty