Provider Demographics
NPI:1255655023
Name:STEPHEN HOLTZCLAW MD PC RENO
Entity Type:Organization
Organization Name:STEPHEN HOLTZCLAW MD PC RENO
Other - Org Name:ST MARY'S HOSPITALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT MANAGER, PE
Authorized Official - Prefix:
Authorized Official - First Name:KAIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-222-0042
Mailing Address - Street 1:PO BOX 3299
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-3299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 W 6TH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4548
Practice Address - Country:US
Practice Address - Phone:775-770-6490
Practice Address - Fax:775-770-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0200X
NV11479208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty