Provider Demographics
NPI:1902838352
Name:TAHOE CARSON RADIOLOGY LOOS ET AL LTD
Entity Type:Organization
Organization Name:TAHOE CARSON RADIOLOGY LOOS ET AL LTD
Other - Org Name:TAHOE CARSON RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-445-5500
Mailing Address - Street 1:PO BOX 1626
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-0028
Mailing Address - Country:US
Mailing Address - Phone:775-283-3315
Mailing Address - Fax:775-852-6902
Practice Address - Street 1:2874 N CARSON ST STE 300
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-1683
Practice Address - Country:US
Practice Address - Phone:775-445-5500
Practice Address - Fax:775-888-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA956AMedicare PIN
NVVWCCBRMedicare PIN