Healthcare Provider Details

I. General information

NPI: 1588676530
Provider Name (Legal Business Name): MCCLINTOCK - HALL, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 PYRAMID WAY STE A
SPARKS NV
89431-2195
US

IV. Provider business mailing address

2415 PYRAMID WAY STE A
SPARKS NV
89431-2195
US

V. Phone/Fax

Practice location:
  • Phone: 775-356-6040
  • Fax: 775-356-7306
Mailing address:
  • Phone: 775-356-6040
  • Fax: 775-356-7306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MELISSA L MILLER
Title or Position: OWNER
Credential: D.O.
Phone: 775-356-6040