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NPI Code Detail

MEDICARE: NORTH TAHOE RADIOLOGY MEDICAL GROUP INC

MEDICARE: NORTH TAHOE RADIOLOGY MEDICAL GROUP INC
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
12085R0202XDiagnostic Radiology PhysicianCA

General Provider Information

NPI Number : 1548210735
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH TAHOE RADIOLOGY MEDICAL GROUP INC
Provider Business Mailing Address
First Line : PO BOX 34120
Second Line :
City : RENO
State : NV
Zip : 89533-4120
Country : US
Telephone Number : 775-747-5050
Fax Number : 775-747-5005
Provider Business Practice Location Address
First Line : 10121 PINE AVE
Second Line :
City : TRUCKEE
State : CA
Zip : 96161-4835
Country : US
Telephone Number : 530-582-3426
Fax Number :
Authorized Official
Title or Position : PARTNER
Name : MYRON L KAMENETSKY
Credential : M.D.
Telephone Number : 530-582-3426
Provider Enumeration Date : 05/11/2006
Last Update Date : 09/20/2016

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