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DME-STATELINE MEDICAL CENTER
NPI 1124334776
Durable Medical Equipment & Medical Supplies in Stateline, NV

Active since August 20, 2010CLIA 05D2078870 · Waiver
155 HWY 50, STATELINE, NV 89449(775) 589-8900(775) 588-7110 Get Directions Write a Review

NPPES record last updated: September 19, 2012. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Dme-stateline Medical Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DME-STATELINE MEDICAL CENTER (NPI 1124334776) is a healthcare organization registered as a durable medical equipment & medical supplies in Stateline, Nevada and active in the NPI registry since August 2010. The organization holds a CLIA Waiver certificate valid through June 4, 2028 and lists Gregory Walter Bergner, President, as its authorized official.

NPPES Registry Identity

NPI1124334776
Entity TypeOrganization
Primary Taxonomy332B00000X
Legal Business NameTAHOE CARSON VALLEY MEDICAL GROUP, INC.
Location Address155 HWY 50Stateline, NV 89449-9800
Mailing Address1111 Emerald Bay RdSouth Lake Tahoe, CA 96150-6207 · (530) 543-5659 · Fax (530) 541-8723
Phone(775) 589-8900
Fax(775) 588-7110
Organization SubpartNo
Authorized OfficialGregory Walter BergnerPresident · (775) 589-8900
Enumeration DateAugust 20, 2010
Last NPPES UpdateSeptember 19, 2012
✔ NPI 1124334776 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDurable Medical Equipment & Medical SuppliesSuppliers
Taxonomy Code332B00000X
Definition

A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

155 HWY 50, Stateline, NV 89449
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Other Names 1

Other NameDme-stateline Medical Center

Other Identifiers 1

Medicare NSC5502710001NV

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2078870

Tahoe Carson Valley Medical Group Inc · South Lake Tahoe, CA
Active · expires Jun 4, 2028
CLIA Number05D2078870
Laboratory TypePhysician Office
Certificate Effective DateJune 5, 2026
Certificate Expiration DateJune 4, 2028
Laboratory DirectorBrian Steixner
Laboratory Phone(530) 543-5440
Laboratory LocationTahoe Carson Valley Medical Group Inc2169 South Ave, South Lake Tahoe, CA 96150
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. STEVEN LAURENCE BROOKS MD
Family Medicine
155 HWY 50
STATELINE, NV 89449
Douglas County (775) 589-8900
DR. PAUL LANCE MARLOWE MD
Family Medicine
155 HWY 50
STATELINE, NV 89449
Douglas County (775) 589-8900
DR. STEVEN DALE LEMAN MD
Emergency Medicine
155 HWY 50, STE 203
STATELINE, NV 89449
Douglas County (775) 589-8949
DR. CLINTON DAVID PURVANCE MD
Emergency Medicine
155 HWY 50, STE 203
STATELINE, NV 89449
Douglas County (775) 589-8949
MICHELLE WILKERSON FEENEY NP
Nurse Practitioner (Family)
155 HWY 50
STATELINE, NV 89449
Douglas County (775) 589-8946
PATRICIA ANNE BUCHER NP
Nurse Practitioner
155 HWY 50
STATELINE, NV 89449
Douglas County (775) 589-8900
DR. JAY CHUNG MD
Internal Medicine (Rheumatology)
155 HWY 50
STATELINE, NV 89449
Douglas County (775) 589-8900
DR. TRACY REGINA PROTELL M.D.
Psychiatry & Neurology (Psychiatry)
155 HWY 50
STATELINE, NV 89449
Douglas County (775) 589-8946

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tahoe Carson Valley Medical Group, Inc.'s NPI number?

The NPI number for Tahoe Carson Valley Medical Group, Inc. is 1124334776. It was assigned to this organization in the NPPES registry on August 20, 2010. The provider is also known as Dme-Stateline Medical Center.

Where is Tahoe Carson Valley Medical Group, Inc. located?

Tahoe Carson Valley Medical Group, Inc. is located at 155 Hwy 50, Stateline, NV 89449. The listed phone number is (775) 589-8900.

What is Tahoe Carson Valley Medical Group, Inc.'s specialty?

The primary specialty registered for this NPI is Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.

Does Tahoe Carson Valley Medical Group, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2078870) is associated with this NPI, valid through June 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Tahoe Carson Valley Medical Group, Inc. was last updated on September 19, 2012. NPI Profile syncs with the weekly NPPES data releases published by CMS.