Healthcare Provider Details

I. General information

NPI: 1750950499
Provider Name (Legal Business Name): BARTON MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 SOUTH AVE
SOUTH LAKE TAHOE CA
96150-7026
US

IV. Provider business mailing address

2170 SOUTH AVE
SOUTH LAKE TAHOE CA
96150-7026
US

V. Phone/Fax

Practice location:
  • Phone: 530-541-3420
  • Fax:
Mailing address:
  • Phone: 530-539-6620
  • Fax: 530-543-5717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY NEIGER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 530-543-5923