Provider Demographics
NPI:1588625883
Name:SAINT MARYS HEALTHFIRST
Entity type:Organization
Organization Name:SAINT MARYS HEALTHFIRST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO/CNE
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIDHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-770-3230
Mailing Address - Street 1:235 W 6TH ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4548
Mailing Address - Country:US
Mailing Address - Phone:775-770-3930
Mailing Address - Fax:775-770-3939
Practice Address - Street 1:235 W 6TH ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4548
Practice Address - Country:US
Practice Address - Phone:775-770-6395
Practice Address - Fax:775-770-6383
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT MARYS HEALTHFIRST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-28
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016874Medicaid
=========OtherIRS - TAX ID
NV40276Medicare PIN