Organization
TAHOE CARSON VALLEY MEDICAL GROUP, INC.
Active
Other names
DME-Stateline Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY WALTER BERGNER MD (PRESIDENT)
(775) 589-8900
Entity
Organization
Contact information
Practice address
155 HWY 50, STATELINE, NV 89449-9800
(775) 589-8900
(775) 588-7110
Mailing address
1111 EMERALD BAY RD, SOUTH LAKE TAHOE, CA 96150-6207
(530) 543-5659
(530) 541-8723
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
08/20/2010
Last updated
09/19/2012
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