Healthcare Provider Details

I. General information

NPI: 1790746089
Provider Name (Legal Business Name): PRIMARY CARE PLUS FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 NEIL RD
RENO NV
89502-6808
US

IV. Provider business mailing address

235 W 6TH ST THIRD FLOOR
RENO NV
89503-4548
US

V. Phone/Fax

Practice location:
  • Phone: 775-770-3780
  • Fax: 775-828-7788
Mailing address:
  • Phone: 775-770-3930
  • Fax: 775-770-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAM KING
Title or Position: CFO
Credential:
Phone: 775-770-6229