Healthcare Provider Details

I. General information

NPI: 1063068930
Provider Name (Legal Business Name): TAHOE FOREST HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10956 DONNER PASS RD STE 110
TRUCKEE CA
96161-4860
US

IV. Provider business mailing address

10121 PINE AVE
TRUCKEE CA
96161-4835
US

V. Phone/Fax

Practice location:
  • Phone: 530-581-8864
  • Fax:
Mailing address:
  • Phone: 530-587-6011
  • Fax:

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL BETTS
Title or Position: CFO
Credential:
Phone: 530-582-6656