Healthcare Provider Details

I. General information

NPI: 1467583450
Provider Name (Legal Business Name): TIMOTHY C MEILNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SW 8TH AVE
CEDAREDGE CO
81413-3902
US

IV. Provider business mailing address

255 SW 8TH AVE
CEDAREDGE CO
81413-3902
US

V. Phone/Fax

Practice location:
  • Phone: 970-856-3146
  • Fax: 970-856-4385
Mailing address:
  • Phone: 970-856-3146
  • Fax: 970-856-4385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32289
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: