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NPI Code Detail

MEDICARE: TAHOE FRACTURE & ORTHOPEDIC MEDICAL CLINIC, INC.

MEDICARE: TAHOE FRACTURE & ORTHOPEDIC MEDICAL CLINIC, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner
2363A00000XPhysician Assistant
3213ES0103XFoot & Ankle Surgery Podiatrist1006NV
4207XS0106XOrthopaedic Hand Surgery Physician
5207XS0117XOrthopaedic Surgery of the Spine Physician
6207X00000XOrthopaedic Surgery Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CC4631OTHERNVBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3C03071OTHERCARAILROAD
4CH0545OTHERNVRAILROAD
5ZZZ49317ZOTHERCAMEDI-CAL

General Provider Information

NPI Number : 1750372140
Entity Type Code : Organization
Provider Name (Legal Business Name) : TAHOE FRACTURE & ORTHOPEDIC MEDICAL CLINIC, INC.
Provider Business Mailing Address
First Line : 973 MICA DR
Second Line : SUITE 201
City : CARSON CITY
State : NV
Zip : 89705-7255
Country : US
Telephone Number : 775-783-6190
Fax Number : 775-783-6191
Provider Business Practice Location Address
First Line : 973 MICA DR
Second Line : SUITE 201
City : CARSON CITY
State : NV
Zip : 89705-7255
Country : US
Telephone Number : 775-783-6190
Fax Number : 775-783-6191
Authorized Official
Title or Position : PHYSICIAN/PARTNER
Name : MR. JEFFREY CUMMINGS
Credential : M.D.
Telephone Number : 775-783-6190
Provider Enumeration Date : 11/03/2005
Last Update Date : 10/12/2011

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Practice Location Address:
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Directions to “TAHOE FRACTURE & ORTHOPEDIC MEDICAL CLINIC, INC. ” Practice Location

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