Provider Demographics
NPI:1477544807
Name:TIMBERLINE RADIOLOGY PA
Entity Type:Organization
Organization Name:TIMBERLINE RADIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:MESERVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-860-8674
Mailing Address - Street 1:PO BOX 2048
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-2048
Mailing Address - Country:US
Mailing Address - Phone:160-386-0867
Mailing Address - Fax:160-344-7431
Practice Address - Street 1:24 PLEASANT ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6151
Practice Address - Country:US
Practice Address - Phone:603-860-8674
Practice Address - Fax:603-447-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01Y002516NH02OtherANTHEM-PROV.#
NH30212757Medicaid
708220OtherCIGNA-PROV.#
NH30212757Medicaid