Basic Information
| Provider Information | |||||||||
| NPI: | 1639306590 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIERRA PODIARTY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 N CARSON ST | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897011216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758821441 | ||||||||
| FaxNumber: | 7758826844 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 N CARSON ST | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897011216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758821441 | ||||||||
| FaxNumber: | 7758826844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2009 | ||||||||
| LastUpdateDate: | 06/24/2009 | ||||||||
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| AuthorizedOfficialLastName: | BEAN | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 7758821441 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 0101 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.