Provider Demographics
NPI:1437214475
Name:TAMARACK MEDICAL CLINIC
Entity Type:Organization
Organization Name:TAMARACK MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-382-4242
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:ID
Mailing Address - Zip Code:83611-0160
Mailing Address - Country:US
Mailing Address - Phone:208-382-4242
Mailing Address - Fax:208-382-3580
Practice Address - Street 1:610 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:DONNELLY
Practice Address - State:ID
Practice Address - Zip Code:83615
Practice Address - Country:US
Practice Address - Phone:208-382-4242
Practice Address - Fax:208-382-3580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID=========OtherTAX NUMBER