Provider Demographics
NPI:1467583450
Name:MEILNER, TIMOTHY C (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:MEILNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAREDGE
Mailing Address - State:CO
Mailing Address - Zip Code:81413-3902
Mailing Address - Country:US
Mailing Address - Phone:970-856-3146
Mailing Address - Fax:970-856-4385
Practice Address - Street 1:255 SW 8TH AVE
Practice Address - Street 2:
Practice Address - City:CEDAREDGE
Practice Address - State:CO
Practice Address - Zip Code:81413-3902
Practice Address - Country:US
Practice Address - Phone:970-856-3146
Practice Address - Fax:970-856-4385
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01322890Medicaid
G29038Medicare UPIN
COC261018Medicare PIN