MEDICARE: LAKE TAHOE ORTHOPAEDIC INSTITUTE, A WATSON-SWANSON PROFESSIONAL CORP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	207XS0106X	Orthopaedic Hand Surgery Physician	NV
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	NV
3	208100000X	Physical Medicine & Rehabilitation Physician	NV
4	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	NV
5	225X00000X	Occupational Therapist	NV
6	363A00000X	Physician Assistant	NV
7	207X00000X	Orthopaedic Surgery Physician	NV

General Provider Information

NPI Number	:	1609937911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE TAHOE ORTHOPAEDIC INSTITUTE, A WATSON-SWANSON PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	2170 SOUTH AVE
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-7026
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	:	89448-8001
Country	:	US
Telephone Number	:	775-589-8950
Fax Number	:	775-588-1299

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KYLE E SWANSON
Credential	:	MD
Telephone Number	:	775-783-3065

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	06/12/2023

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Directions to “LAKE TAHOE ORTHOPAEDIC INSTITUTE, A WATSON-SWANSON PROFESSIONAL CORP ” Practice Location

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