Basic Information
| Provider Information | |||||||||
| NPI: | 1114430311 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PRIME HEALTHCARE SERVICES RENO LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SAINT MARY'S REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 235 W 6TH ST | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895034548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757703000 | ||||||||
| FaxNumber: | 7557703963 | ||||||||
| Practice Location | |||||||||
| Address1: | 235 W 6TH ST | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895034548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757703000 | ||||||||
| FaxNumber: | 7557703963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2017 | ||||||||
| LastUpdateDate: | 11/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | DOAN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF COMPLIANCE COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 9092354307 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 658-HOS-31 | NV | Y | Hospital Units | Psychiatric Unit |
No ID Information.