Healthcare Provider Details

I. General information

NPI: 1902456478
Provider Name (Legal Business Name): CARSON TAHOE REGIONAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 IRONWOOD DR
MINDEN NV
89423-5178
US

IV. Provider business mailing address

PO BOX 2168 1600 MEDICAL PARKWAY
CARSON CITY NV
89702
US

V. Phone/Fax

Practice location:
  • Phone: 775-445-5735
  • Fax:
Mailing address:
  • Phone: 775-445-8672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL WATSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 775-445-8672