| Reno Family Medical Clinic, Llc | |
|
1699 S Virginia St Suite 100 Reno NV 89502-2820 | |
| (775) 742-7028 | |
| (775) 786-8685 |
| Full Name | Reno Family Medical Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1699 S Virginia St, Reno, Nevada |
| Authorized Official Name and Position | Mary Ann Pettit (CREDENTIALING) |
| Authorized Official Contact | 8887373720 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Reno Family Medical Clinic, Llc 1699 S Virginia St Suite 100 Reno NV 89502-2820 Ph: (775) 742-7028 | Reno Family Medical Clinic, Llc 1699 S Virginia St Suite 100 Reno NV 89502-2820 Ph: (775) 742-7028 |
| NPI Number | 1477970325 |
|---|---|
| Provider Enumeration Date | 03/27/2014 |
| Last Update Date | 10/18/2018 |
| Medicare PECOS PAC ID | 5395976435 |
|---|---|
| Medicare Enrollment ID | O20140402001764 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477970325 | NPI | - | NPPES |
| 1235242470 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 11950 (Nevada) | Primary |
| Provider Name | Mohsen Tamasaby |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235242470 PECOS PAC ID: 6709988397 Enrollment ID: I20070228000579 |
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