Timberlake Family Medicine

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

PA303 Issued in ID

Legal business name

TIMBERLAKE FAMILY MEDICINE

Practice address

6101 E Highway 54 Ste a
Athol, ID 83801-8255

Phone

(208) 683-0800

Fax

(208) 683-0900

NPI assigned

Aug 22, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Christopher Ray Sundquist, PA-CNPI 1366510752

Title

Owner

Phone

(208) 683-0800

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christopher Ray Sundquist, PAC

  • Medical Physician Assistant
  • Athol, ID
  • NPI 1366510752
  NPD (past) Authorized official

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1932392933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 775",
            "city": "ATHOL",
            "state": "ID",
            "postal_code": "838010775",
            "telephone_number": "208-683-0800",
            "fax_number": "208-683-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6101 E HIGHWAY 54 STE A",
            "city": "ATHOL",
            "state": "ID",
            "postal_code": "838018255",
            "telephone_number": "208-683-0800",
            "fax_number": "208-683-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMBERLAKE FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-22",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "SUNDQUIST",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-683-0800",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "ID",
            "license": "PA303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "PAD92",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "000010158675",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Sorensen, IBCLC
• Southeast First Assistant LLC
• Charla-Jo Olorenshaw Spradlin, PT
• Amie Lee Storm, LM, CPM
• Christopher Ray Sundquist, PAC
• True North MHW LLC
• Sarah Williams, LPC
• Connie Marie Wilson, FNP

• All providers in Athol, ID
• Primary Care Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2007; 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.