Provider Demographics
NPI:1578600250
Name:RENOWN MEDICAL SCHOOL ASSOCIATES NORTH, INC.
Entity Type:Organization
Organization Name:RENOWN MEDICAL SCHOOL ASSOCIATES NORTH, INC.
Other - Org Name:MEDSCHOOL ASSOCIATES NORTH - PEDIATRICS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO RENOWN HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-982-6488
Mailing Address - Street 1:1155 MILL ST # M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:
Practice Address - Street 1:901 E 2ND ST STE 201
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1186
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV30470Medicaid
NV100500708Medicaid