Organization
TIMBERLINE CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHRYN L. YOUNG (PRESIDENT)
(719) 836-3455
Entity
Organization
Contact information
Practice address
980 MAIN ST., FAIRPLAY, CO 80440-0723
(719) 836-3455
(719) 836-1792
Mailing address
PO BOX 723, 980 MAIN ST., FAIRPLAY, CO 80440-0723
(719) 836-3455
(719) 836-1792
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
43262
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01
CO PACIFICARE
CO
05
—
01219609
—
CO
05
—
04008850
—
CO
05
—
07100753
—
CO
01
—
500000326
RAILROAD MEDICARE
CO
01
—
SH29090
CO BLUE SHIELD
CO
01
—
YO634320
CO BLUE SHIELD
CO
Enumeration date
04/17/2007
Last updated
05/18/2016
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