1902838352 NPI number — TAHOE CARSON RADIOLOGY LOOS ET AL LTD

Table of content: (NPI 1902838352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902838352 NPI number — TAHOE CARSON RADIOLOGY LOOS ET AL LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAHOE CARSON RADIOLOGY LOOS ET AL LTD
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:
TAHOE CARSON RADIOLOGY
Provider Other Organization Name Type Code:
3
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:
1902838352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1626
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47706-0028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-283-3315
Provider Business Mailing Address Fax Number:
775-852-6902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2874 N CARSON ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARSON CITY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89706-1683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-445-5500
Provider Business Practice Location Address Fax Number:
775-888-0202
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAKI
Authorized Official First Name:
ERIK
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
775-445-5500

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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