=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598215493
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUGAR PINE FAMILY MEDICINE P.C., PAUL SMITH, MD, ET AL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2016
-----------------------------------------------------
Last Update Date | 10/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5542 LONGLEY LN
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89511-1886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-321-1044
-----------------------------------------------------
Fax | 775-851-6862
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5542 LONGLEY LN
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89511-1886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-321-1044
-----------------------------------------------------
Fax | 775-851-6862
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | KAREN M PHILLIPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 775-321-1044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 8731
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------