# TAMARACK EAGLE MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tamarack Medical & Dental Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255621835
- **Authorized official:** DR. ROURKE YEAKLEY M.D. (SOLE MEMBER)
- **Authorized official phone:** (208) 724-7420

## Contact information

- **Practice address:** 311 VILLAGE DR, TAMARACK, ID 83615-5014
- **Practice address phone:** (208) 724-7420
- **Mailing address:** 5701 WILLOW CREEK RD, EAGLE, ID 83616-2025
- **Mailing address phone:** (208) 724-7420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | — |
| 208D00000X | General Practice Physician | M8190 | ID | Yes |

## Other

- **Enumeration date:** 04/15/2011
- **Last updated:** 04/15/2011