Provider Demographics
NPI:1154631703
Name:BARTON HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:BARTON HEALTHCARE SYSTEM
Other - Org Name:BARTON FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DERBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-543-5841
Mailing Address - Street 1:1111 EMERALD BAY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6207
Mailing Address - Country:US
Mailing Address - Phone:530-543-5659
Mailing Address - Fax:530-541-8723
Practice Address - Street 1:1090 3RD ST
Practice Address - Street 2:STE 1
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-3485
Practice Address - Country:US
Practice Address - Phone:530-543-5660
Practice Address - Fax:530-542-1619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2017-04-19
Deactivation Date:2015-05-22
Deactivation Code:
Reactivation Date:2017-04-19
Provider Licenses
StateLicense IDTaxonomies
CA0300000676261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care