Provider Demographics
NPI:1902456478
Name:CARSON TAHOE REGIONAL HEALTHCARE
Entity Type:Organization
Organization Name:CARSON TAHOE REGIONAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-445-8672
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:1600 MEDICAL PARKWAY
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702
Mailing Address - Country:US
Mailing Address - Phone:775-445-8672
Mailing Address - Fax:
Practice Address - Street 1:925 IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-5178
Practice Address - Country:US
Practice Address - Phone:775-445-5735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARSON TAHOE REGIONAL HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV001213843Medicaid
NV001013843Medicaid
NV001113843Medicaid