Provider Demographics
NPI:1003903527
Name:SIENA HILLS PRIMARY CARE
Entity Type:Organization
Organization Name:SIENA HILLS PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-614-0850
Mailing Address - Street 1:2789 SUNRIDGE HEIGHTS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5052
Mailing Address - Country:US
Mailing Address - Phone:702-614-0850
Mailing Address - Fax:702-614-0798
Practice Address - Street 1:2789 SUNRIDGE HEIGHTS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-614-0850
Practice Address - Fax:702-614-0798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV33480Medicare PIN
NVF89338Medicare UPIN