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General NPI Number Information
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NPI Number | 1679897037
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Entity Type | Organization
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Legal Business Name | CARSON TAHOE PHYSICIAN CLINICS
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 925 IRONWOOD DRIVE SUITE 2107
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City | MINDEN
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State | NV
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Zip | 89423-5180
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Country | US
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Telephone | 775-445-7838
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Fax | 775-445-7898
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Provider Business Mailing Address
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Address Line | 2874 N. CARSON STREET SUITE 200
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City | CARSON CITY
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State | NV
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Zip | 89706-0251
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Country | US
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Telephone | 775-283-3096
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Fax | 775-283-3091
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Authorized Official
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Title or Position | VP HR/SUPPORT SERVICES
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Name | RICHARD LAWLEY
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Credential |
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Telephone | 775-445-8689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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