Basic Information
| Provider Information | |||||||||
| NPI: | 1780721480 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNSOM MULTISPECIALTY GROUP PRACTICE NORTH, INC. | ||||||||
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| OtherOrganizationName: | MEDSCHOOL ASSOCIATES, NORTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 W 2ND ST | ||||||||
| Address2: | #235D | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895035345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757841223 | ||||||||
| FaxNumber: | 7753272006 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 LOCUST ST | ||||||||
| Address2: | MAIL STOP 355 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895022597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757844202 | ||||||||
| FaxNumber: | 7753271769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 02/11/2014 | ||||||||
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| AuthorizedOfficialLastName: | MURPHY | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 7757841223 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100500708 | 05 | NV | MEDICAID |