Healthcare Provider Details

I. General information

NPI: 1003872904
Provider Name (Legal Business Name): TAMARACK LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 RAGLAND RD
BECKLEY WV
25801-9722
US

IV. Provider business mailing address

PO BOX 1102
BECKLEY WV
25802-1102
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-6500
  • Fax: 304-253-5420
Mailing address:
  • Phone: 304-255-6500
  • Fax: 304-253-5420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN H JOHNSON JR.
Title or Position: CEO
Credential:
Phone: 304-255-6500