Basic Information
| Provider Information | |||||||||
| NPI: | 1225499486 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEATH FAMILY MEDICAL PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34120 | ||||||||
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| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895334120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757475050 | ||||||||
| FaxNumber: | 7757475005 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 COMMERCIAL WAY | ||||||||
| Address2: | |||||||||
| City: | FALLON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894062600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754237575 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2016 | ||||||||
| LastUpdateDate: | 08/04/2016 | ||||||||
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| AuthorizedOfficialLastName: | HEATH | ||||||||
| AuthorizedOfficialFirstName: | JUSTIN | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7754237575 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DO1587 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.