Organization
SLT MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWIN EMMANUEL NEBBLETT MD (CEO)
(575) 654-5188
Entity
Organization
Contact information
Practice address
2024 LAKE TAHOE BLVD, SOUTH LAKE TAHOE, CA 96150-6498
(406) 334-7470
Mailing address
PO BOX 910, WEIMAR, CA 95736-0910
(575) 654-5188
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
04/03/2020
Last updated
04/03/2020
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