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General NPI Number Information
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NPI Number | 1366183584
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Entity Type | Organization
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Legal Business Name | TIMBER MEDICAL AND PAIN CENTER PLLC
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Dates
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Enumeration Date | 04/03/2022
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Last Update Date | 04/03/2022
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Provider Practice Location Address
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Address Line | 2451 S WHITE MOUNTAIN RD
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City | SHOW LOW
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State | AZ
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Zip | 85901-7306
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Country | US
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Telephone | 928-532-7599
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Fax | 928-532-8599
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Provider Business Mailing Address
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Address Line | 6019 RIM RD
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City | LAKESIDE
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State | AZ
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Zip | 85929-5092
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Country | US
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Telephone | 210-632-2807
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Fax | 928-532-8599
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Authorized Official
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Title or Position | OWNER
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Name | MR. JASON FRANK PACE
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Credential | PA
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Telephone | 210-632-2807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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