Provider Demographics
NPI:1255310124
Name:SIERRA NEVADA MEDICAL IMAGING
Entity Type:Organization
Organization Name:SIERRA NEVADA MEDICAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SILK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-297-0300
Mailing Address - Street 1:PO BOX 19879
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2533
Mailing Address - Country:US
Mailing Address - Phone:888-480-6640
Mailing Address - Fax:775-852-6902
Practice Address - Street 1:2170 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150
Practice Address - Country:US
Practice Address - Phone:559-297-0300
Practice Address - Fax:530-542-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507836Medicaid
NVCA7623OtherRR MEDICARE
NV100507852Medicaid
CACA7624OtherRR MEDICARE
CAGR0099310Medicaid
CAZZZ21998ZMedicare PIN
CACA7624OtherRR MEDICARE