| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 7111 S Virginia St, Reno, Nevada |
| Authorized Official Name and Position | Jennifer Hornback (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7758515700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7111 S Virginia St Reno NV 89511 Ph: (775) 851-5700 | 7111 S Virginia St Reno NV 89511 Ph: (775) 851-5700 |
| NPI Number | 1487690350 |
|---|---|
| Provider Enumeration Date | 06/21/2006 |
| Last Update Date | 05/09/2019 |
| Medicare PECOS PAC ID | 3476570433 |
|---|---|
| Medicare Enrollment ID | O20051028000458 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487690350 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ambika Uppu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821285784 PECOS PAC ID: 0840346011 Enrollment ID: I20090914000591 |
| Provider Name | Suraj P Verma |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134253701 PECOS PAC ID: 3577619956 Enrollment ID: I20090928000104 |
| Provider Name | James F Schaupp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770679706 PECOS PAC ID: 9931297546 Enrollment ID: I20100222000235 |
| Provider Name | Jennifer Hornback |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952497950 PECOS PAC ID: 8022106632 Enrollment ID: I20100222000288 |
| Provider Name | Timothy D Coughlin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487740460 PECOS PAC ID: 4486742095 Enrollment ID: I20100331000297 |
| Provider Name | Leslie Stockholm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790260578 PECOS PAC ID: 9032454012 Enrollment ID: I20190222001299 |
| Provider Name | Jyotsna Ganta |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1528402260 PECOS PAC ID: 9830493014 Enrollment ID: I20210810003489 |
Functional Medicine Of Nevada Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6490 S Mccarran Blvd Ste 16, Reno, NV 89509 Phone: 208-385-7711 | |
John R. Lemieux Md Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6630 S. Mccorran Blvd, Building B Suite 16, Reno, NV 89509 Phone: 775-323-5116 Fax: 775-323-7140 | |
Kelly King Md Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1180 Sharon Way, Reno, NV 89509 Phone: 775-376-1507 | |
Dr. Gary Danchak, Omd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9393 Gateway Dr, Reno, NV 89521 Phone: 775-849-9800 Fax: 775-849-9801 | |