Provider Demographics
NPI:1023311305
Name:NORTH TAHOE ORTHOPEDICS
Entity type:Organization
Organization Name:NORTH TAHOE ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-587-7461
Mailing Address - Street 1:10051 LAKE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0445
Mailing Address - Country:US
Mailing Address - Phone:530-587-7461
Mailing Address - Fax:530-587-1149
Practice Address - Street 1:10051 LAKE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0445
Practice Address - Country:US
Practice Address - Phone:530-587-7461
Practice Address - Fax:530-587-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81163207X00000X, 174400000X
CAG88857174400000X
CAA101686174400000X
CAPA22841363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6530720001OtherMEDICARE DMEPOS PTAN
CAEM658AOtherMEDICARE PTAN