Healthcare Provider Details

I. General information

NPI: 1750502134
Provider Name (Legal Business Name): CAPITOL ORTHOPEDICS AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 N ROOP ST NUMBER 101
CARSON CITY NV
89701-3106
US

IV. Provider business mailing address

PO BOX 34120
RENO NV
89533-4120
US

V. Phone/Fax

Practice location:
  • Phone: 775-888-9197
  • Fax: 775-747-5005
Mailing address:
  • Phone: 775-747-5050
  • Fax: 775-747-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number6610
License Number StateNV

VIII. Authorized Official

Name: JOSEPH P. WALLS
Title or Position: OWNER
Credential: M.D.
Phone: 775-888-9197