Provider Demographics
NPI:1720103674
Name:HILLBRICK FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:HILLBRICK FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:HILLBRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:775-783-0624
Mailing Address - Street 1:PO BOX 2170
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-2170
Mailing Address - Country:US
Mailing Address - Phone:775-783-0624
Mailing Address - Fax:775-783-0639
Practice Address - Street 1:1685 US HIGHWAY 395 N
Practice Address - Street 2:SUITE A
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4327
Practice Address - Country:US
Practice Address - Phone:775-783-0624
Practice Address - Fax:775-783-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV641080OtherBLUE SHEILD
NV641080OtherBLUE SHEILD
NV101291Medicare PIN