1023311305 NPI number — NORTH TAHOE ORTHOPEDICS

Table of content: DR. KIM A CARMICHAEL MD (NPI 1417907742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023311305 NPI number — NORTH TAHOE ORTHOPEDICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH TAHOE ORTHOPEDICS
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:
1023311305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10051 LAKE AVE
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
TRUCKEE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96161-0445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-587-7461
Provider Business Mailing Address Fax Number:
530-587-1149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10051 LAKE AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
TRUCKEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96161-0445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-587-7461
Provider Business Practice Location Address Fax Number:
530-587-1149
Provider Enumeration Date:
12/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SMALL
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
530-587-7461

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  A81163 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6530720001 . This is a "MEDICARE DMEPOS PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: EM658A . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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