1063068930 NPI number — TAHOE FOREST HOSPITAL DISTRICT

Table of content: MS. KAREN W. SELLEY CRNA (NPI 1114946837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063068930 NPI number — TAHOE FOREST HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAHOE FOREST HOSPITAL DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063068930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10121 PINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUCKEE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96161-4835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-587-6011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10956 DONNER PASS RD STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUCKEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96161-4860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-581-8864
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BETTS
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
530-582-6656

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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