MEDICARE: CARSON TAHOE REGIONAL HEALTHCARE

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	261QE0002X	Emergency Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902456478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARSON TAHOE REGIONAL HEALTHCARE

Provider Business Mailing Address
First Line	:	PO BOX 2168
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89702-2168
Country	:	US
Telephone Number	:	775-445-8672
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 IRONWOOD DR
Second Line	:
City	:	MINDEN
State	:	NV
Zip	:	89423-5178
Country	:	US
Telephone Number	:	775-445-5735
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	KATIE KUCERA
Credential	:
Telephone Number	:	775-445-5543

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	02/04/2026

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