Healthcare Provider Details

I. General information

NPI: 1720144579
Provider Name (Legal Business Name): HOGLE MILLER & WARD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 ERRECART BLVD SUITE 102
ELKO NV
89801-8336
US

IV. Provider business mailing address

1995 ERRECART BLVD SUITE 102
ELKO NV
89801-8336
US

V. Phone/Fax

Practice location:
  • Phone: 775-738-3111
  • Fax: 775-778-6728
Mailing address:
  • Phone: 775-738-3111
  • Fax: 775-778-6728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMARA B KIEHN
Title or Position: CLINIC MANAGER
Credential: RN BSN
Phone: 775-777-0215