1104851625 NPI number — TAMARAC MEDICAL INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104851625 NPI number — TAMARAC MEDICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAMARAC MEDICAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104851625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3959 E ARAPAHOE RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80122-2070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-794-1083
Provider Business Mailing Address Fax Number:
303-794-1093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3959 E ARAPAHOE RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
CENTENNIAL
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80122-2070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-794-1083
Provider Business Practice Location Address Fax Number:
303-794-1093
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSENBAUM
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
JOE
Authorized Official Title or Position:
LABORATORY DIRECTOR
Authorized Official Telephone Number:
303-794-1083

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  06D0899927 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00666014A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100759250A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 343719100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100245360A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146949709 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1662275 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 705766301 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08002669 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200061470 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000100188 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0123731 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: J4463 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0153711 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06D0899927 . This is a "CLIA NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6705072000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: C05800044 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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