Healthcare Provider Details

I. General information

NPI: 1023790045
Provider Name (Legal Business Name): TIMBERLAND MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MEDICAL PKWY STE 140
CEDAR PARK TX
78613-2529
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 512-379-3660
  • Fax:
Mailing address:
  • Phone: 615-778-8196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER L JACKSON
Title or Position: SNR DIRECTOR, PROVIDER ENROLLMENT
Credential:
Phone: 615-465-3334