Provider Demographics
NPI:1003120650
Name:SAINT MARY'S MULTI-SPECIALTY CLINIC, INC.
Entity Type:Organization
Organization Name:SAINT MARY'S MULTI-SPECIALTY CLINIC, INC.
Other - Org Name:SAINT MARY'S CLINIC AT WALMART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RATTIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-770-7044
Mailing Address - Street 1:645 N ARLINGTON AVE STE 555
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4452
Mailing Address - Country:US
Mailing Address - Phone:775-770-7661
Mailing Address - Fax:775-770-7368
Practice Address - Street 1:5065 PYRAMID WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-7703
Practice Address - Country:US
Practice Address - Phone:775-770-7664
Practice Address - Fax:775-770-7358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT MARY'S MULTI-SPECIALTY CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-05
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center