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General NPI Number Information
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NPI Number | 1619007176
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Entity Type | Organization
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Legal Business Name | WILDCREEK FAMILY MEDICAL CENTER
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 2125 GREEN VISTA DR SUITE 106
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City | SPARKS
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State | NV
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Zip | 89431-8545
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Country | US
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Telephone | 775-673-6681
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Fax | 775-673-6682
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Provider Business Mailing Address
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Address Line | 2125 GREEN VISTA DR SUITE 106
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City | SPARKS
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State | NV
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Zip | 89431-8545
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Country | US
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Telephone | 775-673-6681
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Fax | 775-673-6682
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Authorized Official
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Title or Position | OWNER
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Name | PHILLIS MAXINE BOYD
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Credential | DO
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Telephone | 775-673-6681
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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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