Provider Demographics
NPI:1194721977
Name:TIMBERLINE MEDICAL SUPPLY
Entity type:Organization
Organization Name:TIMBERLINE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-367-6834
Mailing Address - Street 1:PO BOX 2310
Mailing Address - Street 2:
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935-2310
Mailing Address - Country:US
Mailing Address - Phone:928-367-6834
Mailing Address - Fax:928-367-6838
Practice Address - Street 1:674 E WHITE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:PINETOP
Practice Address - State:AZ
Practice Address - Zip Code:85935-7064
Practice Address - Country:US
Practice Address - Phone:928-367-6834
Practice Address - Fax:928-367-6838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09016499T332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ371732Medicaid
AZ371732Medicaid