Provider Demographics
NPI:1336773373
Name:TCK ISLAY, INC
Entity Type:Organization
Organization Name:TCK ISLAY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NUZUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-782-0700
Mailing Address - Street 1:1624 10TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-4477
Mailing Address - Country:US
Mailing Address - Phone:775-782-0700
Mailing Address - Fax:775-782-0500
Practice Address - Street 1:1624 10TH ST STE 1
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4477
Practice Address - Country:US
Practice Address - Phone:775-782-0700
Practice Address - Fax:775-782-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty