Healthcare Provider Details

I. General information

NPI: 1821581430
Provider Name (Legal Business Name): TIMBUS ANESTHESIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E 19TH ST
THE DALLES OR
97058-3317
US

IV. Provider business mailing address

275 LONE PINE LN
THE DALLES OR
97058-9724
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-1111
  • Fax:
Mailing address:
  • Phone: 541-390-7020
  • Fax: 541-769-0741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD14731
License Number StateOR

VIII. Authorized Official

Name: DR. CHARLES KENT ANDERSON
Title or Position: CEO/ANESTHESIOLOGIST
Credential: MD
Phone: 541-390-7020