Basic Information
| Provider Information | |||||||||
| NPI: | 1700973591 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BARTON HEALTHCARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 EMERALD BAY RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH LAKE TAHOE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961506207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305435659 | ||||||||
| FaxNumber: | 5305418723 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 HIGHWAY 50 | ||||||||
| Address2: | |||||||||
| City: | STATELINE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894499816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7755898949 | ||||||||
| FaxNumber: | 7755898979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 11/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | PURVANCE | ||||||||
| AuthorizedOfficialFirstName: | CLINTON | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 5305413420 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X | NV | Y | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
No ID Information.