Healthcare Provider Details

I. General information

NPI: 1649239575
Provider Name (Legal Business Name): TIMBERVIEW CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S POTOMAC ST SUITE 215
AURORA CO
80012-4528
US

IV. Provider business mailing address

1400 S POTOMAC ST SUITE 215
AURORA CO
80012-4528
US

V. Phone/Fax

Practice location:
  • Phone: 303-306-1039
  • Fax: 303-306-1050
Mailing address:
  • Phone: 303-306-1039
  • Fax: 303-306-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number77105,77106
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number208011, 206336
License Number StateCO

VIII. Authorized Official

Name: MR. RON SHARP
Title or Position: OFFICE MANAGER
Credential:
Phone: 303-269-4464