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NPI Code Detail

MEDICARE: ELITE SPORTS MEDICINE LLC

MEDICARE: ELITE SPORTS MEDICINE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery Podiatrist2060NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11861413445OTHERNVINDIVIDUAL NPI

General Provider Information

NPI Number : 1104095611
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELITE SPORTS MEDICINE LLC
Provider Business Mailing Address
First Line : 1875 PLUMAS ST
Second Line : STE 6A
City : RENO
State : NV
Zip : 89509-3321
Country : US
Telephone Number : 775-786-5333
Fax Number : 775-786-5336
Provider Business Practice Location Address
First Line : 1875 PLUMAS ST
Second Line : STE 6A
City : RENO
State : NV
Zip : 89509-3387
Country : US
Telephone Number : 775-786-5333
Fax Number : 775-786-5336
Authorized Official
Title or Position : OWNER
Name : DR. TRACEY GIAMBRONE
Credential : D.P.M.
Telephone Number : 775-786-5333
Provider Enumeration Date : 02/28/2008
Last Update Date : 03/13/2008

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Directions to “ELITE SPORTS MEDICINE LLC ” Practice Location

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