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Tahoe Carson Valley Medical Group, INC.

Durable Medical Equipment & Medical Supplies in Stateline, NV. Organization (NPI-2).

NPI number1124334776
StatusActive
Last updated in NPPESSep 19, 2012

Details

NPI
1124334776
Entity type
Organization (NPI-2)
Legal business name
Tahoe Carson Valley Medical Group, INC.
Organization subpart
No
Enumeration date
Aug 20, 2010
Last updated
Sep 19, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
332B00000X Durable Medical Equipment & Medical Supplies––Yes

Other names

  • Dme-Stateline Medical Center (Other Name)

Practice location

155 Hwy 50
Stateline, NV 89449-9800

Phone 775-589-8900 · Fax 775-588-7110

Mailing address

1111 Emerald Bay Rd
South Lake Tahoe, CA 96150-6207

Phone 530-543-5659 · Fax 530-541-8723

Authorized official

Gregory Walter Bergner
President
7755898900

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