Provider Demographics
NPI:1063630747
Name:OWENS, CHARLES G
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:G
Last Name:OWENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HOT SPRINGS RD
Mailing Address - Street 2:# 5E
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-1601
Mailing Address - Country:US
Mailing Address - Phone:775-884-9024
Mailing Address - Fax:775-884-9024
Practice Address - Street 1:101 HOT SPRINGS RD
Practice Address - Street 2:# 5E
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-1601
Practice Address - Country:US
Practice Address - Phone:775-884-9024
Practice Address - Fax:775-884-9024
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA03021OtherMEDICAL DME
NV4714210001Medicare ID - Type Unspecified