Provider Demographics
NPI:1578843983
Name:CARSON TAHOE PHYSICIAN CLINICS
Entity type:Organization
Organization Name:CARSON TAHOE PHYSICIAN CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HINEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-445-7291
Mailing Address - Street 1:775 FLEISCHMANN WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706
Mailing Address - Country:US
Mailing Address - Phone:775-445-7291
Mailing Address - Fax:775-888-3230
Practice Address - Street 1:775 FLEISCHMANN WAY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706
Practice Address - Country:US
Practice Address - Phone:775-445-7338
Practice Address - Fax:775-888-3231
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARSON TAHOE PHYSICIAN CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty