Provider Demographics
NPI:1760443709
Name:PVHS/TIMBERLINE, LLC
Entity Type:Organization
Organization Name:PVHS/TIMBERLINE, LLC
Other - Org Name:TIMBERLINE MEDICAL, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SELL PREMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-586-2343
Mailing Address - Street 1:131 STANLEY AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-6363
Mailing Address - Country:US
Mailing Address - Phone:970-586-2343
Mailing Address - Fax:970-586-9060
Practice Address - Street 1:131 STANLEY AVE
Practice Address - Street 2:STE 202
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-6363
Practice Address - Country:US
Practice Address - Phone:970-586-2343
Practice Address - Fax:970-586-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12383376Medicaid
COC513128Medicare PIN