Provider Demographics
NPI:1740683515
Name:TAMBER HEALTH OF MINNESOTA, P.C.
Entity type:Organization
Organization Name:TAMBER HEALTH OF MINNESOTA, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:RUNDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-482-6237
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL BAY
Mailing Address - State:MN
Mailing Address - Zip Code:55323-0178
Mailing Address - Country:US
Mailing Address - Phone:855-482-6237
Mailing Address - Fax:952-405-9163
Practice Address - Street 1:2657 WOODBRIDGE RD
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-9406
Practice Address - Country:US
Practice Address - Phone:855-482-6237
Practice Address - Fax:952-405-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47562103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty