|
| |
|
1715 Kuenzli Street Reno NV 89502-1117 | |
| (775) 329-5162 | |
| (775) 334-4350 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1715 Kuenzli Street, Reno, Nevada |
| Authorized Official Name and Position | Elvin Willie (ACTING CLINIC DIRECTOR) |
| Authorized Official Contact | 7753295162 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1715 Kuenzli Street Reno NV 89502-1117 Ph: (775) 329-5162 | 1715 Kuenzli Street Reno NV 89502-1117 Ph: (775) 329-5162 |
| NPI Number | 1497700801 |
|---|---|
| Provider Enumeration Date | 05/23/2006 |
| Last Update Date | 05/24/2012 |
| Medicare PECOS PAC ID | 6507761897 |
|---|---|
| Medicare Enrollment ID | O20031201000208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497700801 | NPI | - | NPPES |
| 004716904 | Medicaid | NV | |
| 003116904 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (Nevada) | Primary |
| Provider Name | David Prothro |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1942208426 PECOS PAC ID: 1254395171 Enrollment ID: I20050128000275 |
| Provider Name | Andrew K Bader |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1932437589 PECOS PAC ID: 7315994639 Enrollment ID: I20050407000918 |
| Provider Name | Saide Altinsan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689612079 PECOS PAC ID: 8022026368 Enrollment ID: I20060329000282 |
| Provider Name | Garnet M Yokoi |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1487845731 PECOS PAC ID: 2466545611 Enrollment ID: I20100420000571 |
| Provider Name | Taira L Enewold |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1134454218 PECOS PAC ID: 4385884931 Enrollment ID: I20130703000124 |
| Provider Name | Earl S Nielsen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043338593 PECOS PAC ID: 8527284645 Enrollment ID: I20140728000143 |
| Provider Name | Tonya R. Hubbard |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1275580896 PECOS PAC ID: 9133139850 Enrollment ID: I20171228002401 |
| Provider Name | Craig M Black |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1912083916 PECOS PAC ID: 3476506619 Enrollment ID: I20180406002314 |
| Provider Name | Laura Nielsen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235408360 PECOS PAC ID: 6002240058 Enrollment ID: I20210413002361 |
| Provider Name | Nathanael Duane Mellum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194300152 PECOS PAC ID: 1658771548 Enrollment ID: I20210615000904 |
| Provider Name | Eloy Ituarte |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1982633194 PECOS PAC ID: 2062894900 Enrollment ID: I20220809001705 |
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 | |