Provider Demographics
NPI:1982882940
Name:TIMPVIEW SPINAL CARE, LLC
Entity Type:Organization
Organization Name:TIMPVIEW SPINAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:BIDDULPH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-434-4555
Mailing Address - Street 1:309 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4747
Mailing Address - Country:US
Mailing Address - Phone:801-434-4555
Mailing Address - Fax:801-434-8333
Practice Address - Street 1:309 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4747
Practice Address - Country:US
Practice Address - Phone:801-434-4555
Practice Address - Fax:801-434-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6880100-8007261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center