Provider Demographics
NPI:1518941525
Name:TIMOTHY J TREIBLE MD PC
Entity Type:Organization
Organization Name:TIMOTHY J TREIBLE MD PC
Other - Org Name:EAST PORTLAND ORTHOPEDIC AND FRACTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TREIBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:503-255-5388
Mailing Address - Street 1:135 NE 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4167
Mailing Address - Country:US
Mailing Address - Phone:503-255-5388
Mailing Address - Fax:503-255-5085
Practice Address - Street 1:135 NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4167
Practice Address - Country:US
Practice Address - Phone:503-255-5388
Practice Address - Fax:503-255-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH1163OtherRR MEDICARE
CH1163OtherRR MEDICARE
OR0561530001Medicare NSC