# SLT MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902435894
- **Authorized official:** DR. EDWIN EMMANUEL NEBBLETT MD (CEO)
- **Authorized official phone:** (575) 654-5188

## Contact information

- **Practice address:** 2024 LAKE TAHOE BLVD, SOUTH LAKE TAHOE, CA 96150-6498
- **Practice address phone:** (406) 334-7470
- **Mailing address:** PO BOX 910, WEIMAR, CA 95736-0910
- **Mailing address phone:** (575) 654-5188

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/03/2020
- **Last updated:** 04/03/2020