Healthcare Provider Details

I. General information

NPI: 1104802297
Provider Name (Legal Business Name): SIERRA REGIONAL SPINE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6630 S MCCARRAN BLVD STE A4 SIERRA REGIONAL SPINE INSTITUTE
RENO NV
89509-6158
US

IV. Provider business mailing address

6630 S MCCARRAN BLVD STE A4 SIERRA REGIONAL SPINE INSTITUTE
RENO NV
89509-6158
US

V. Phone/Fax

Practice location:
  • Phone: 775-828-2873
  • Fax: 775-828-2889
Mailing address:
  • Phone: 775-828-2873
  • Fax: 775-828-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number StateNV

VIII. Authorized Official

Name: MRS. PENNY A FORBES
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 775-828-2873