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NPI Code Detail

MEDICARE: SAINT MARYS MEDICAL GROUP INC.

MEDICARE: SAINT MARYS MEDICAL GROUP INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1861757577
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAINT MARYS MEDICAL GROUP INC.
Provider Business Mailing Address
First Line : 645 N ARLINGTON AVE
Second Line : SUITE 555
City : RENO
State : NV
Zip : 89503-4460
Country : US
Telephone Number : 775-770-7661
Fax Number :
Provider Business Practice Location Address
First Line : 5065 PYRAMID WAY
Second Line :
City : SPARKS
State : NV
Zip : 89436-7703
Country : US
Telephone Number : 775-770-7664
Fax Number : 775-770-7358
Authorized Official
Title or Position : DEPUTY GENERAL COUNSEL
Name : RADHA SAVITALA
Credential :
Telephone Number : 909-235-4308
Provider Enumeration Date : 07/09/2012
Last Update Date : 11/21/2013

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Directions to “SAINT MARYS MEDICAL GROUP INC. ” Practice Location

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