Provider Demographics
NPI:1649475419
Name:INCLINE VILLAGE URGENT CARE INC
Entity type:Organization
Organization Name:INCLINE VILLAGE URGENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HEILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-833-2929
Mailing Address - Street 1:995 TAHOE BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89451-9574
Mailing Address - Country:US
Mailing Address - Phone:775-833-2929
Mailing Address - Fax:775-833-0277
Practice Address - Street 1:995 TAHOE BLVD STE 301
Practice Address - Street 2:
Practice Address - City:INCLINE VILLAGE
Practice Address - State:NV
Practice Address - Zip Code:89451-9574
Practice Address - Country:US
Practice Address - Phone:775-833-2929
Practice Address - Fax:775-833-0277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
V35289Medicare ID - Type Unspecified
E25270Medicare UPIN