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NPI Code Detail

MEDICARE: TAHOE EMERGENCY PHYSICIANS MEDICAL CORPORATION

MEDICARE: TAHOE EMERGENCY PHYSICIANS MEDICAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician

General Provider Information

NPI Number : 1104937408
Entity Type Code : Organization
Provider Name (Legal Business Name) : TAHOE EMERGENCY PHYSICIANS MEDICAL CORPORATION
Provider Business Mailing Address
First Line : PO BOX 849174
Second Line :
City : LOS ANGELES
State : CA
Zip : 90084-9174
Country : US
Telephone Number : 775-901-1563
Fax Number :
Provider Business Practice Location Address
First Line : 2170 SOUTH AVE
Second Line :
City : SOUTH LAKE TAHOE
State : CA
Zip : 96150-7026
Country : US
Telephone Number : 530-541-3420
Fax Number :
Authorized Official
Title or Position : AO
Name : THOMAS JOSEPH JANTOS
Credential :
Telephone Number : 775-901-1563
Provider Enumeration Date : 08/31/2006
Last Update Date : 01/02/2026

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Directions to “TAHOE EMERGENCY PHYSICIANS MEDICAL CORPORATION ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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