Provider Demographics
NPI:1205216090
Name:TIMBERLANDS HEALTHCARE, LLC
Entity Type:Organization
Organization Name:TIMBERLANDS HEALTHCARE, LLC
Other - Org Name:TIMBERLANDS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-446-4500
Mailing Address - Street 1:1 CHISHOLM TRL
Mailing Address - Street 2:STE 400
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5008
Mailing Address - Country:US
Mailing Address - Phone:512-481-7060
Mailing Address - Fax:
Practice Address - Street 1:1050 E LOOP 304
Practice Address - Street 2:SUITE 200
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-1814
Practice Address - Country:US
Practice Address - Phone:936-544-5132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health