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General NPI Number Information
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NPI Number | 1104851625
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Entity Type | Organization
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Legal Business Name | TAMARAC MEDICAL INC
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 03/21/2016
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Provider Practice Location Address
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Address Line | 3959 E ARAPAHOE RD STE 100
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City | CENTENNIAL
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State | CO
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Zip | 80122-2070
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Country | US
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Telephone | 303-794-1083
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Fax | 303-794-1093
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Provider Business Mailing Address
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Address Line | 3959 E ARAPAHOE RD STE 100
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City | CENTENNIAL
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State | CO
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Zip | 80122-2070
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Country | US
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Telephone | 303-794-1083
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Fax | 303-794-1093
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | DR. RICHARD JOE ROSENBAUM
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Credential | MD
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Telephone | 303-794-1083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 06D0899927
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License Number State | CO
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