Healthcare Provider Details

I. General information

NPI: 1750731055
Provider Name (Legal Business Name): MCCORMACK SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10791 DOUBLE R BLVD
RENO NV
89521-8956
US

IV. Provider business mailing address

10791 DOUBLE R BLVD
RENO NV
89521-8956
US

V. Phone/Fax

Practice location:
  • Phone: 775-284-2020
  • Fax: 775-284-2023
Mailing address:
  • Phone: 775-284-2020
  • Fax: 775-284-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number7939-OPF-1
License Number StateNV

VIII. Authorized Official

Name: JUDY LYNNE THOMAS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 775-284-2020