Provider Demographics
NPI:1679853089
Name:CARSON TAHOE PHYSICIAN CLINICS
Entity Type:Organization
Organization Name:CARSON TAHOE PHYSICIAN CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HINEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-445-7291
Mailing Address - Street 1:1201 S CARSON STREET
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701
Mailing Address - Country:US
Mailing Address - Phone:775-445-7337
Mailing Address - Fax:775-841-1142
Practice Address - Street 1:1200 MOUTAIN STREET
Practice Address - Street 2:SUITE 220
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703
Practice Address - Country:US
Practice Address - Phone:775-883-6888
Practice Address - Fax:775-883-4915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARSON TAHOE PHYSICIAN CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty