1598215493 NPI number — SUGAR PINE FAMILY MEDICINE P.C., PAUL SMITH, MD, ET AL

Table of content: DR. CHELSEA NICOLE KILLINGSWORTH DMD (NPI 1063038875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598215493 NPI number — SUGAR PINE FAMILY MEDICINE P.C., PAUL SMITH, MD, ET AL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUGAR PINE FAMILY MEDICINE P.C., PAUL SMITH, MD, ET AL
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:
1598215493
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5542 LONGLEY LN
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:
89511-1886
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-321-1044
Provider Business Mailing Address Fax Number:
775-851-6862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5542 LONGLEY LN
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:
89511-1886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-321-1044
Provider Business Practice Location Address Fax Number:
775-851-6862
Provider Enumeration Date:
10/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
775-321-1044

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  8731 , 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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