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General NPI Number Information
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NPI Number | 1104937408
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Entity Type | Organization
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Legal Business Name | TAHOE EMERGENCY PHYSICIANS MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 2170 SOUTH AVE
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-7026
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Country | US
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Telephone | 530-541-3420
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 849174
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City | LOS ANGELES
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State | CA
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Zip | 90084-9174
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Country | US
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Telephone | 775-901-1563
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Fax |
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Authorized Official
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Title or Position | AO
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Name | THOMAS JOSEPH JANTOS
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Credential |
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Telephone | 775-901-1563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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