SLT Medical Group Inc

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

SLT MEDICAL GROUP INC

Practice address

2024 Lake Tahoe Blvd
South Lake Tahoe, CA 96150-6498

Phone

(406) 334-7470

NPI assigned

Apr 3, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Edwin Emmanuel Nebblett, MD

Title

Ceo

Phone

(575) 654-5188

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585872000000",
    "number": "1902435894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 910",
            "city": "WEIMAR",
            "state": "CA",
            "postal_code": "957360910",
            "telephone_number": "575-654-5188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2024 LAKE TAHOE BLVD",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961506498",
            "telephone_number": "406-334-7470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SLT MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-03",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "status": "A",
        "authorized_official_last_name": "NEBBLETT",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_middle_name": "EMMANUEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "575-654-5188",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Silk, M.D.
• David Matthew Silkey, MPT, CSCS
• Erik Silverman, PT
• Ilia Garcia Sippel, DDS
• Sky Lake Recovery Center, LLC
• Sheree Smail
• Faye M. Smith-Chakmakova, MD
• Amy Pittlick Smith, NP
• Mary Rhonda Sneeringer, MD
• Samantha Snyder

• Rural Health Clinic/Center in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Rural Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.