Provider Demographics
NPI:1417273541
Name:THE NEVADA CENTER FOR REPRODUCTIVE MEDICINE
Entity Type:Organization
Organization Name:THE NEVADA CENTER FOR REPRODUCTIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOULK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-828-1200
Mailing Address - Street 1:645 SIERRA ROSE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2366
Mailing Address - Country:US
Mailing Address - Phone:775-828-1200
Mailing Address - Fax:775-828-1785
Practice Address - Street 1:645 SIERRA ROSE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2366
Practice Address - Country:US
Practice Address - Phone:775-828-1200
Practice Address - Fax:775-828-1785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty