MEDICARE: LAKE TAHOE ORTHOPAEDIC INSTITUTE

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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1598914186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE TAHOE ORTHOPAEDIC INSTITUTE

Provider Business Mailing Address
First Line	:	1111 EMERALD BAY RD
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-6207
Country	:	US
Telephone Number	:	530-543-5659
Fax Number	:	530-541-8723

Provider Business Practice Location Address
First Line	:	212 ELKS POINT RD STE 200
Second Line	:
City	:	ZEPHYR COVE
State	:	NV
Zip	:	89448-9800
Country	:	US
Telephone Number	:	775-589-8950
Fax Number	:	775-588-1299

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN M BANNAR
Credential	:	MD
Telephone Number	:	530-541-3100

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	09/19/2012

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