Tamarack Eagle Medical

NPI 1255621835 - Dentist - 122300000X

NPI Details
NPI 1255621835
Enumeration Date 04/15/2011
Last Updated 04/15/2011
Entity Type Healthcare Provider
Active Over 5 years ago
Authorized Information
Name ROURKE ROURKE
Position SOLE MEMBER
Phone (208) 724-7420
Fax
Practice Location
311 VILLAGE DR
TAMARACK ID, 83615-5014, US
Phone (208) 724-7420
Fax
Business Location
5701 WILLOW CREEK RD
EAGLE ID, 83616-2025, US
Phone (208) 724-7420
Fax
Toxanomy
Taxonomy Code 122300000X
License State
License Number
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According to our database, Tamarack Eagle Medical NPI is 1255621835, taxonomy code is 122300000X Tamarack Eagle Medical physically located at 311 Village Dr, Tamarack ID, 83615-5014. NPI Number 1033115704 has the healthcare provider type.

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1255621835 NPI number is provided on an as is basis without warranty of any kind. 1255621835 is maintained by the National Plan & Provider Enumeration System. The contents of Tamarack Eagle Medical are for informational purposes only.