Provider Demographics
NPI:1265527246
Name:TIMBERLINE PHYSICIANS, P.C.
Entity type:Organization
Organization Name:TIMBERLINE PHYSICIANS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-793-7220
Mailing Address - Street 1:4677 TOWNE CENTRE RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2846
Mailing Address - Country:US
Mailing Address - Phone:989-793-7220
Mailing Address - Fax:989-793-7482
Practice Address - Street 1:800 S. WASHINGTON AVE.
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601
Practice Address - Country:US
Practice Address - Phone:989-907-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N85370OtherMEDICARE GROUP IDENTIFIER
MI0G36084OtherMEDICARE ID