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General NPI Number Information
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NPI Number | 1619656139
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Entity Type | Organization
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Legal Business Name | PINNACLE MEDICAL GROUP, HICKS PC
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Dates
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Enumeration Date | 07/12/2023
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 5990 SILVER LAKE RD STE C
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City | RENO
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State | NV
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Zip | 89506-2300
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Country | US
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Telephone | 775-972-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 5975 S LOS ALTOS PKWY STE 9
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City | SPARKS
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State | NV
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Zip | 89436-7699
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Country | US
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Telephone | 775-204-4000
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MARIA ELVIRA ROGERS
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Credential |
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Telephone | 775-848-5125
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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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