Provider Demographics
NPI:1700963725
Name:BARTON HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:BARTON HEALTHCARE SYSTEM
Other - Org Name:LAKE TAHOE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:D
Authorized Official - Last Name:PURVANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-543-5840
Mailing Address - Street 1:2170 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7026
Mailing Address - Country:US
Mailing Address - Phone:530-541-3420
Mailing Address - Fax:530-541-8723
Practice Address - Street 1:212 ELKS POINT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ZEPHYR COVE
Practice Address - State:NV
Practice Address - Zip Code:89448-8001
Practice Address - Country:US
Practice Address - Phone:775-588-9188
Practice Address - Fax:775-588-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1888ASC261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1700963725Medicaid
CA050352Medicare Oscar/Certification
NV1700963725Medicaid