Organization
TIMBERLAKE FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER RAY SUNDQUIST PA-C (OWNER)
(208) 683-0800
Entity
Organization
Contact information
Practice address
6101 E HIGHWAY 54 STE A, ATHOL, ID 83801-8255
(208) 683-0800
(208) 683-0900
Mailing address
PO BOX 775, ATHOL, ID 83801-0775
(208) 683-0800
(208) 683-0900
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
PA303
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010158675
REGENCE
—
01
—
PAD92
BLUE CROSS
—
Enumeration date
08/22/2007
Last updated
08/22/2007
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