Healthcare Provider Details

I. General information

NPI: 1447568787
Provider Name (Legal Business Name): CARSON TAHOE PHYSICIAN CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3770 US HWY 395 SO
CARSON CITY NV
89705-6898
US

IV. Provider business mailing address

1201 S. CARSON STREET
CARSON CITY NV
89701
US

V. Phone/Fax

Practice location:
  • Phone: 775-445-7220
  • Fax: 775-445-7271
Mailing address:
  • Phone: 775-445-7337
  • Fax: 775-841-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN00519
License Number StateNV

VIII. Authorized Official

Name: JAMES M HINEY
Title or Position: DIRECTOR
Credential:
Phone: 775-445-7290