Provider Demographics
NPI:1104851625
Name:TAMARAC MEDICAL INC
Entity Type:Organization
Organization Name:TAMARAC MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:ROSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-794-1083
Mailing Address - Street 1:3959 E ARAPAHOE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2070
Mailing Address - Country:US
Mailing Address - Phone:303-794-1083
Mailing Address - Fax:303-794-1093
Practice Address - Street 1:3959 E ARAPAHOE RD
Practice Address - Street 2:STE 100
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-2070
Practice Address - Country:US
Practice Address - Phone:303-794-1083
Practice Address - Fax:303-794-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO06D0899927291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00666014AMedicaid
OK100759250AMedicaid
MN343719100Medicaid
KS100245360AMedicaid
AR146949709Medicaid
LA1662275Medicaid
MO705766301Medicaid
CO08002669Medicaid
IN200061470Medicaid
VA000100188Medicaid
MS0123731Medicaid
NMJ4463Medicaid
OH0153711Medicaid
06D0899927OtherCLIA NUMBER
WV6705072000Medicaid
CAC05800044Medicaid
IN200061470Medicaid
UT=========001Medicaid
CAC05800044Medicaid
MS0123731Medicaid