Basic Information
| Provider Information | |||||||||
| NPI: | 1194115394 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DARDICK - ELKO PC | ||||||||
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| OtherOrganizationName: | NORTHEASTERN NEVADA RADIATION ONCOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1044 JACKSON FELTS RD | ||||||||
| Address2: | |||||||||
| City: | JOELTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370804839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157464711 | ||||||||
| FaxNumber: | 6152960952 | ||||||||
| Practice Location | |||||||||
| Address1: | 2003 ERRECART BLVD | ||||||||
| Address2: | |||||||||
| City: | ELKO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757484673 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2015 | ||||||||
| LastUpdateDate: | 01/23/2017 | ||||||||
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| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6157464711 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.