Provider Demographics
NPI:1720338585
Name:TAHOE FRACTURE AND ORTHOPEDIC MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:TAHOE FRACTURE AND ORTHOPEDIC MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-783-6190
Mailing Address - Street 1:973 MICA DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89705-7255
Mailing Address - Country:US
Mailing Address - Phone:775-783-6190
Mailing Address - Fax:775-783-6191
Practice Address - Street 1:2874 N CARSON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-0251
Practice Address - Country:US
Practice Address - Phone:775-283-3321
Practice Address - Fax:775-841-9485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies