Provider Demographics
NPI:1275703373
Name:PINION ROAD CLINIC
Entity Type:Organization
Organization Name:PINION ROAD CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-778-0386
Mailing Address - Street 1:1780 BROWNING WAY
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:775-777-1152
Practice Address - Street 1:1780 BROWNING WAY
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8312
Practice Address - Country:US
Practice Address - Phone:775-778-0386
Practice Address - Fax:775-777-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG14284Medicare UPIN
NVV32435Medicare PIN