1205098555 NPI number — NORTH VALLEY MEDICAL ASSOCIATES

Table of content: (NPI 1205098555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205098555 NPI number — NORTH VALLEY MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH VALLEY MEDICAL ASSOCIATES
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:
NORTH VALLEY MEDICAL ASSOCIATES
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:
1205098555
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10555 STEAD BLVD
Provider Second Line Business Mailing Address:
STE 10
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89506-1871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-971-3300
Provider Business Mailing Address Fax Number:
775-971-3307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6542 S MCCARRAN BLVD
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89509-6142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-329-3434
Provider Business Practice Location Address Fax Number:
775-329-5362
Provider Enumeration Date:
06/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PAIVA
Authorized Official First Name:
ROSE
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
775-329-3434

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  9005 , 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: 100506378 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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