1225225576 NPI number — NORTH VALLEY MEDICAL ASSOCIATES

Table of content: (NPI 1225225576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225225576 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 URGENT CARE
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:
1225225576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6542 S MCCARRAN BLVD
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89509-6142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-329-3484
Provider Business Mailing Address Fax Number:
775-329-5362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10555 STEAD BLVD
Provider Second Line Business Practice Location Address:
STE 10
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89506-1871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-971-3300
Provider Business Practice Location Address Fax Number:
775-971-3307
Provider Enumeration Date:
10/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PAIVA
Authorized Official First Name:
ROSE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER MD
Authorized Official Telephone Number:
775-329-3484

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  9005 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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)





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