Provider Demographics
NPI:1144810318
Name:QUICK CARE TAHOE PROVIDERS MEDICAL CORPORATION
Entity type:Organization
Organization Name:QUICK CARE TAHOE PROVIDERS MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:LEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-318-1775
Mailing Address - Street 1:2020 KOKANEE WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6629
Mailing Address - Country:US
Mailing Address - Phone:530-318-1775
Mailing Address - Fax:
Practice Address - Street 1:2074 LAKE TAHOE BLVD STE 9
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6417
Practice Address - Country:US
Practice Address - Phone:530-600-2117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty