Healthcare Provider Details

I. General information

NPI: 1366183584
Provider Name (Legal Business Name): TIMBER MEDICAL AND PAIN CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2022
Last Update Date: 04/03/2022
Certification Date: 04/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 S WHITE MOUNTAIN RD
SHOW LOW AZ
85901-7306
US

IV. Provider business mailing address

6019 RIM RD
LAKESIDE AZ
85929-5092
US

V. Phone/Fax

Practice location:
  • Phone: 928-532-7599
  • Fax: 928-532-8599
Mailing address:
  • Phone: 210-632-2807
  • Fax: 928-532-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON FRANK PACE
Title or Position: OWNER
Credential: PA
Phone: 210-632-2807