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General NPI Number Information
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NPI Number | 1750372140
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Entity Type | Organization
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Legal Business Name | TAHOE FRACTURE & ORTHOPEDIC MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 973 MICA DR SUITE 201
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City | CARSON CITY
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State | NV
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Zip | 89705-7255
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Country | US
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Telephone | 775-783-6190
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Fax | 775-783-6191
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Provider Business Mailing Address
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Address Line | 973 MICA DR SUITE 201
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City | CARSON CITY
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State | NV
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Zip | 89705-7255
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Country | US
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Telephone | 775-783-6190
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Fax | 775-783-6191
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Authorized Official
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Title or Position | PHYSICIAN/PARTNER
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Name | MR. JEFFREY CUMMINGS
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Credential | M.D.
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Telephone | 775-783-6190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 1006
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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