Organization
CARSON TAHOE PHYSICIAN CLINICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YOLANDA ROMO (ADMINISTRATIVE ASSIST)
(775) 283-3096
Entity
Organization
Contact information
Practice address
901 MEDICAL CENTER DR, SUITE 102, DAYTON, NV 89403-7458
(775) 445-7621
(775) 283-3091
Mailing address
2874 N CARSON ST, SUITE 200, CARSON CITY, NV 89706-0251
(775) 283-3096
(775) 283-3091
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BQ020Z
MEDICARE PTAN
NV
Enumeration date
12/31/2009
Last updated
02/02/2010
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