Organization
TAHOE FRACTURE & ORTHOPEDIC MEDICAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY CUMMINGS M.D. (PHYSICIAN/PARTNER)
(775) 783-6190
Entity
Organization
Contact information
Practice address
973 MICA DR, SUITE 201, CARSON CITY, NV 89705-7255
(775) 783-6190
(775) 783-6191
Mailing address
973 MICA DR, SUITE 201, CARSON CITY, NV 89705-7255
(775) 783-6190
(775) 783-6191
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
1006
NV
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100506168
—
NV
01
—
C03071
RAILROAD
CA
01
—
CC4631
BCBS
NV
01
—
CH0545
RAILROAD
NV
01
—
ZZZ49317Z
MEDI-CAL
CA
Enumeration date
11/03/2005
Last updated
10/12/2011
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