MEDICARE: THE NEVADA CENTER

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
1	207R00000X	Internal Medicine Physician	4951	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1346300035	OTHER	NV	NONE

General Provider Information

NPI Number	:	1972901320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE NEVADA CENTER

Provider Business Mailing Address
First Line	:	1231 COUNTRY CLUB DR
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-8372
Country	:	US
Telephone Number	:	775-884-3990
Fax Number	:	775-884-2202

Provider Business Practice Location Address
First Line	:	1231 COUNTRY CLUB DR
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-8372
Country	:	US
Telephone Number	:	775-884-3990
Fax Number	:	775-884-2202

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	FRANK ANTHONY SHALLENBERGER
Credential	:	MD
Telephone Number	:	775-884-3990

Provider Enumeration Date	:	12/17/2014
Last Update Date	:	12/17/2014

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Directions to “THE NEVADA CENTER ” Practice Location

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