Healthcare Provider Details

I. General information

NPI: 1477544807
Provider Name (Legal Business Name): TIMBERLINE RADIOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 PLEASANT ST SUITE 1A
CONWAY NH
03818-6151
US

IV. Provider business mailing address

PO BOX 2048
CONWAY NH
03818-2048
US

V. Phone/Fax

Practice location:
  • Phone: 603-860-8674
  • Fax: 603-447-4310
Mailing address:
  • Phone: 160-386-0867
  • Fax: 160-344-7431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CLAIRE PATRICIA MESERVE
Title or Position: BILLING MANAGER
Credential:
Phone: 603-860-8674