1386654911 NPI number — ROBERT G BERRY JR LTD

Table of content: (NPI 1386654911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386654911 NPI number — ROBERT G BERRY JR LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT G BERRY JR 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:
ORTHOPEDIC REHABILITATION SPECIALIST OF NEVADA
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:
1386654911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6630 S MCCARRAN BLVD STE A3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89509-6136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-828-2863
Provider Business Mailing Address Fax Number:
775-448-9447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6630 S MCCARRAN BLVD STE A3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89509-6184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-828-2863
Provider Business Practice Location Address Fax Number:
866-571-0056
Provider Enumeration Date:
08/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GEORGETTA
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
775-448-9456

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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