Provider Demographics
NPI:1821081696
Name:TRUCKEE TAHOE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:TRUCKEE TAHOE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLODAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-581-8864
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96160-0068
Mailing Address - Country:US
Mailing Address - Phone:530-581-8864
Mailing Address - Fax:
Practice Address - Street 1:10956 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4861
Practice Address - Country:US
Practice Address - Phone:530-581-8864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty