1497780167 NPI number — NEVADA FAMILY PRACTICE RESIDENCY PROGRAM, INC.

Table of content: (NPI 1497780167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497780167 NPI number — NEVADA FAMILY PRACTICE RESIDENCY PROGRAM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEVADA FAMILY PRACTICE RESIDENCY PROGRAM, INC.
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:
MOJAVE ADULT, CHILD AND FAMILY SERVICES
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:
1497780167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
745 W MOANA LN
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89509-4932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-334-3033
Provider Business Mailing Address Fax Number:
775-334-3022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
745 W MOANA LN
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89509-4932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-334-3033
Provider Business Practice Location Address Fax Number:
775-334-3022
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARCELLS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-968-5059

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100507636 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100508691 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100508050 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100508692 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100507635 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100507630 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100507632 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100507633 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100507631 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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