MEDICARE: TIMBERLANDS HEALTHCARE, LLC

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1205216090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMBERLANDS HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	1 CHISHOLM TRL
Second Line	:	STE 400
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5008
Country	:	US
Telephone Number	:	512-481-7060
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 E LOOP 304
Second Line	:	SUITE 200
City	:	CROCKETT
State	:	TX
Zip	:	75835-1814
Country	:	US
Telephone Number	:	936-544-5132
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JEFFERY MADISON
Credential	:
Telephone Number	:	512-446-4500

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	11/08/2016

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