MEDICARE: TIMBERLINE MEDICAL SUPPLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	09016499T	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194721977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMBERLINE MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	PO BOX 2310
Second Line	:
City	:	PINETOP
State	:	AZ
Zip	:	85935-2310
Country	:	US
Telephone Number	:	928-367-6834
Fax Number	:	928-367-6838

Provider Business Practice Location Address
First Line	:	674 E WHITE MOUNTAIN BLVD
Second Line	:
City	:	PINETOP
State	:	AZ
Zip	:	85935-7064
Country	:	US
Telephone Number	:	928-367-6834
Fax Number	:	928-367-6838

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JERRY L ARMSTRONG
Credential	:
Telephone Number	:	928-367-6834

Provider Enumeration Date	:	06/25/2005
Last Update Date	:	08/22/2020

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Directions to “TIMBERLINE MEDICAL SUPPLY ” Practice Location

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