1881139970 NPI number — RENO SURGICAL ASSOCIATES (CHU)

Table of content: (NPI 1881139970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881139970 NPI number — RENO SURGICAL ASSOCIATES (CHU)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENO SURGICAL ASSOCIATES (CHU)
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:
RENO SURGICAL ASSOCIATES (VANDERCLAY)
Provider Other Organization Name Type Code:
4
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:
1881139970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 E 2ND ST STE 206
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:
89502-1198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-789-7050
Provider Business Mailing Address Fax Number:
775-789-7038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 E 2ND ST STE 206
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:
89502-1198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-789-7065
Provider Business Practice Location Address Fax Number:
775-789-7038
Provider Enumeration Date:
12/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FREEMAN
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
CATHERINE
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
775-789-7065

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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