Healthcare Provider Details

I. General information

NPI: 1316162795
Provider Name (Legal Business Name): UROLOGY NEVADA LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5560 KIETZKE LN. BLDG. A
RENO NV
89511
US

IV. Provider business mailing address

5560 KIETZKE LN. BLDG. A
RENO NV
89511
US

V. Phone/Fax

Practice location:
  • Phone: 775-322-7811
  • Fax: 775-322-1431
Mailing address:
  • Phone: 775-322-7811
  • Fax: 775-322-1431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberNV20071378617
License Number StateNV

VIII. Authorized Official

Name: STEPHEN GABELICH
Title or Position: BILLING MANAGER
Credential:
Phone: 775-322-7811