Provider Demographics
NPI:1407158900
Name:NORTHERN NEVADA SURGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NORTHERN NEVADA SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHULTHEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-335-9008
Mailing Address - Street 1:10085 DOUBLE R BLVD
Mailing Address - Street 2:205
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5860
Mailing Address - Country:US
Mailing Address - Phone:775-335-9008
Mailing Address - Fax:
Practice Address - Street 1:10085 DOUBLE R BLVD
Practice Address - Street 2:205
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5860
Practice Address - Country:US
Practice Address - Phone:775-335-9008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty