Organization
CARSON TAHOE PHYSICIAN CLINICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAGGIE L IVERSON MBA, FACMPE (DIRECTOR)
(775) 283-3096
Entity
Organization
Contact information
Practice address
925 IRONWOOD DR, #2108, MINDEN, NV 89423-5178
(775) 445-7929
(775) 783-8889
Mailing address
2874 N CARSON ST, #200, CARSON CITY, NV 89706-0251
(775) 883-9003
(775) 883-0959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023265717
MEDICARE
NV
05
—
1023265717
—
NV
Enumeration date
08/04/2009
Last updated
08/04/2009
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