Provider Demographics
NPI:1386293520
Name:TAMARA TCM ACUPUNCTURE & HERBS
Entity type:Organization
Organization Name:TAMARA TCM ACUPUNCTURE & HERBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-345-4996
Mailing Address - Street 1:120 W DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-2141
Mailing Address - Country:US
Mailing Address - Phone:419-345-4996
Mailing Address - Fax:877-961-4515
Practice Address - Street 1:120 W DUDLEY ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-2141
Practice Address - Country:US
Practice Address - Phone:419-345-4996
Practice Address - Fax:877-961-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty