Timber Valley Medical Clinic P C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DO 08511 Issued in OR

Legal business name

TIMBER VALLEY MEDICAL CLINIC P C

Practice address

21 Hayden Bridge Way
Springfield, OR 97477-1305

Phone

(541) 741-1226

Fax

(541) 714-0673

NPI assigned

Nov 14, 2006

Organization subpart

No

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

Authorized official

Name

Dr. George Martin Larson III, D.O.

Title

Corporation President

Phone

(541) 741-1226

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Timber Valley Family Clinic Former legal business name

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1871665901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 HAYDEN BRIDGE WAY",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771305",
            "telephone_number": "541-741-1226",
            "fax_number": "541-714-0673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 HAYDEN BRIDGE WAY",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771305",
            "telephone_number": "541-741-1226",
            "fax_number": "541-714-0673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMBER VALLEY MEDICAL CLINIC P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "CORPORATION PRESIDENT",
        "authorized_official_telephone_number": "541-741-1226",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO 08511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CJ9204",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240511",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Timber Valley Family Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Susan Tibbitts-Hernandez, R.N.
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• Stacy Tindall
• Emily Tinguely, PA-C
• Deborah Tipitino, RN
• Abhinav Tiwari, MD

• Family Medicine Physician in Springfield, OR
• Providers in Springfield, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.