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General NPI Number Information
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NPI Number | 1316925381
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Entity Type | Organization
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Legal Business Name | EASTERN SIERRA MEDICAL GROUP LLC
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 3595 US HIGHWAY 50
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City | SILVER SPRINGS
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State | NV
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Zip | 89429-9613
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Country | US
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Telephone | 775-982-5000
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Fax | 775-982-3900
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Provider Business Mailing Address
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Address Line | 1155 MILL ST # M14
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City | RENO
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State | NV
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Zip | 89502-1576
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Country | US
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Telephone | 775-982-5262
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Fax | 775-982-5496
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Authorized Official
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Title or Position | CFO ACUTE CARE
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Name | BRETT MOORE
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Credential |
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Telephone | 775-982-6343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 7714RHC-0
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License Number State | NV
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