Healthcare Provider Details

I. General information

NPI: 1700963725
Provider Name (Legal Business Name): BARTON HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 ELKS POINT RD SUITE 201
ZEPHYR COVE NV
89448-8001
US

IV. Provider business mailing address

2170 SOUTH AVE
SOUTH LAKE TAHOE CA
96150-7026
US

V. Phone/Fax

Practice location:
  • Phone: 775-588-9188
  • Fax: 775-588-4337
Mailing address:
  • Phone: 530-541-3420
  • Fax: 530-541-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1888ASC
License Number StateNV

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1700963725
Identifier TypeMEDICAID
Identifier StateNV
Identifier Issuer

VIII. Authorized Official

Name: DR. CLINTON D PURVANCE
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 530-543-5840