Provider Demographics
NPI:1902458896
Name:TAMARACK FAMILY MEDICINE
Entity Type:Organization
Organization Name:TAMARACK FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISING ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-851-0999
Mailing Address - Street 1:109 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8524
Mailing Address - Country:US
Mailing Address - Phone:802-851-0999
Mailing Address - Fax:
Practice Address - Street 1:109 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8524
Practice Address - Country:US
Practice Address - Phone:321-615-8328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-11
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center