Provider Demographics
NPI:1083890255
Name:CAROLYN E. SIMMONS MD PC
Entity Type:Organization
Organization Name:CAROLYN E. SIMMONS MD PC
Other - Org Name:THE CORNER DOC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-329-2444
Mailing Address - Street 1:890 MILL ST
Mailing Address - Street 2:#200
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1442
Mailing Address - Country:US
Mailing Address - Phone:775-329-2444
Mailing Address - Fax:775-329-2440
Practice Address - Street 1:890 MILL ST
Practice Address - Street 2:#200
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1442
Practice Address - Country:US
Practice Address - Phone:775-329-2444
Practice Address - Fax:775-329-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36005Medicare PIN