Provider Demographics
NPI:1366183584
Name:TIMBER MEDICAL AND PAIN CENTER PLLC
Entity type:Organization
Organization Name:TIMBER MEDICAL AND PAIN CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:210-632-2807
Mailing Address - Street 1:6019 RIM RD
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5092
Mailing Address - Country:US
Mailing Address - Phone:210-632-2807
Mailing Address - Fax:928-532-8599
Practice Address - Street 1:2451 S WHITE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7306
Practice Address - Country:US
Practice Address - Phone:928-532-7599
Practice Address - Fax:928-532-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-03
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain