1912027988 NPI number — WESTERN NEVADA FOOT AND ANKLE CENTER

Table of content: (NPI 1912027988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912027988 NPI number — WESTERN NEVADA FOOT AND ANKLE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN NEVADA FOOT AND ANKLE 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:
Provider Other Organization Name Type Code:
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:
1912027988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 39000
Provider Second Line Business Mailing Address:
DEPT 34159
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94139-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-284-3668
Provider Business Mailing Address Fax Number:
775-284-4254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 MCCABE DR
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89511-5991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-284-3668
Provider Business Practice Location Address Fax Number:
775-284-4254
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOONEY
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
775-284-3668

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DE5177 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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