Provider Demographics
NPI:1225235187
Name:SPECIALTY HEALTH CLINIC
Entity Type:Organization
Organization Name:SPECIALTY HEALTH CLINIC
Other - Org Name:SPECIALTY HEALTH CLINIC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-398-3603
Mailing Address - Street 1:330 E LIBERTY STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501
Mailing Address - Country:US
Mailing Address - Phone:775-398-3603
Mailing Address - Fax:775-329-9921
Practice Address - Street 1:330 E LIBERTY STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501
Practice Address - Country:US
Practice Address - Phone:775-398-3603
Practice Address - Fax:775-329-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV97547174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVE84988Medicare UPIN
VWJBJNMedicare PIN
143315Medicare UPIN
NV171411Medicare UPIN
P88207Medicare UPIN
S89858Medicare UPIN