Provider Demographics
NPI:1023265717
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:MBA, FACMPE
Authorized Official - Phone:775-445-7291
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:89706-1682
Mailing Address - Country:US
Mailing Address - Phone:775-883-9003
Mailing Address - Fax:775-883-0959
Practice Address - Street 1:2874 N CARSON STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-1682
Practice Address - Country:US
Practice Address - Phone:775-883-9003
Practice Address - Fax:775-883-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty