Basic Information
| Provider Information | |||||||||
| NPI: | 1043719636 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIERRA SURGICAL ONCOLOGY CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34120 | ||||||||
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| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895334120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757455050 | ||||||||
| FaxNumber: | 7753268298 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 PRINGLE WAY STE 906 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895028405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759826270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2018 | ||||||||
| LastUpdateDate: | 02/08/2018 | ||||||||
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| AuthorizedOfficialLastName: | GALANOPOULOS | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOS | ||||||||
| AuthorizedOfficialMiddleName: | ANAST | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7759826270 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 12854 | NV | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.