Timber Ridge Holdings LLC

Primary specialty

Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X

Legal business name

TIMBER RIDGE HOLDINGS LLC

Practice address

448 E 5350 S Ste B
Washington Terrace, UT 84405-5415

Phone

(801) 540-4564

NPI assigned

Aug 18, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brian Pennocks, DTP

Title

Medical Director

Phone

(801) 698-1160

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1250553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250553600000",
    "number": "1508098906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "448 E 5350 S STE B",
            "city": "WASHINGTON TERRACE",
            "state": "UT",
            "postal_code": "844055415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "448 E 5350 S STE B",
            "city": "WASHINGTON TERRACE",
            "state": "UT",
            "postal_code": "844055415",
            "telephone_number": "801-540-4564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMBER RIDGE HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-18",
        "last_updated": "2009-08-18",
        "status": "A",
        "authorized_official_last_name": "PENNOCKS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "801-698-1160",
        "authorized_official_credential": "DTP"
    },
    "taxonomies": [
        {
            "code": "2084N0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.