1518937820 NPI number — RENOWN SOUTH MEADOWS MEDICAL CENTER

Table of content: (NPI 1518937820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518937820 NPI number — RENOWN SOUTH MEADOWS MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENOWN SOUTH MEADOWS MEDICAL CENTER
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:
RENOWN REHABILITATION HOSPITAL
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:
1518937820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30019
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:
89520-3019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-982-7000
Provider Business Mailing Address Fax Number:
775-982-7089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1495 MILL STREET
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:
89502-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-982-3500
Provider Business Practice Location Address Fax Number:
775-982-9009
Provider Enumeration Date:
01/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BECK
Authorized Official First Name:
ANN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
775-982-6488

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , with the licence number:  657HOS-16 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100502742 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5616006 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP33672 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29T049 . This is a "BLUE CROSS OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CC7514 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: USA291780 . This is a "BLUE SHIELD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 100502741 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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