Provider Demographics
NPI:1568517894
Name:TIMPANOGOS FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:TIMPANOGOS FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:HARLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-426-8141
Mailing Address - Street 1:423 N OREM BLVD
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-8813
Mailing Address - Country:US
Mailing Address - Phone:801-426-8141
Mailing Address - Fax:801-426-8142
Practice Address - Street 1:423 N OREM BLVD
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-8813
Practice Address - Country:US
Practice Address - Phone:801-426-8141
Practice Address - Fax:801-426-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT30880353-1205261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107008924101OtherSELECT HEALTH
UT46D0979491OtherCLIA
UT30880351204001OtherBLUE CROSS BLUE SHIELD
UT552530959002Medicaid
UT552530959002Medicaid
UT30880351204001OtherBLUE CROSS BLUE SHIELD