Provider Demographics
NPI:1659695005
Name:CARSON TAHOE PHYSICIAN CLINICS
Entity Type:Organization
Organization Name:CARSON TAHOE PHYSICIAN CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP HR/SUPPORT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-445-8689
Mailing Address - Street 1:2874 N. CARSON STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0251
Mailing Address - Country:US
Mailing Address - Phone:775-283-3096
Mailing Address - Fax:775-283-3091
Practice Address - Street 1:1535 MEDICAL PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4367
Practice Address - Country:US
Practice Address - Phone:775-445-7690
Practice Address - Fax:775-883-5992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty