MEDICARE: TAHOE FOREST HOSPITAL DISTRICT

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1790281186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAHOE FOREST HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	10121 PINE AVE
Second Line	:
City	:	TRUCKEE
State	:	CA
Zip	:	96161-4835
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 ALDER AVE
Second Line	:
City	:	INCLINE VILLAGE
State	:	NV
Zip	:	89451-8335
Country	:	US
Telephone Number	:	775-883-4100
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	CRYSTAL BETTS
Credential	:
Telephone Number	:	530-582-6656

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	04/04/2018

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Directions to “TAHOE FOREST HOSPITAL DISTRICT ” Practice Location

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