Provider Demographics
NPI:1073584322
Name:RENOWN REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:RENOWN REGIONAL MEDICAL CENTER
Other - Org Name:RENOWN HEALTH DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-982-6488
Mailing Address - Street 1:PO BOX 30006
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89520-3006
Mailing Address - Country:US
Mailing Address - Phone:866-691-0284
Mailing Address - Fax:866-691-4313
Practice Address - Street 1:3310 GONI RD
Practice Address - Street 2:SUITE 171
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-7917
Practice Address - Country:US
Practice Address - Phone:775-886-6450
Practice Address - Fax:775-982-8104
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENOWN REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-26
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV501ESR-9261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV001216885Medicaid
NV001216885Medicaid
293500Medicare PIN