Provider Demographics
NPI:1235409939
Name:CARSON TAHOE URGENT CARE
Entity Type:Organization
Organization Name:CARSON TAHOE URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-445-7337
Mailing Address - Street 1:1201 S CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5225
Mailing Address - Country:US
Mailing Address - Phone:775-445-7337
Mailing Address - Fax:445-841-1139
Practice Address - Street 1:901 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-7458
Practice Address - Country:US
Practice Address - Phone:775-445-7201
Practice Address - Fax:775-236-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care