Provider Demographics
NPI:1619348422
Name:HOLISTIC HEALTH CENTER OF RENO
Entity Type:Organization
Organization Name:HOLISTIC HEALTH CENTER OF RENO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:775-870-1545
Mailing Address - Street 1:890 MILL ST
Mailing Address - Street 2:200
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1442
Mailing Address - Country:US
Mailing Address - Phone:775-686-6336
Mailing Address - Fax:775-686-6327
Practice Address - Street 1:890 MILL ST
Practice Address - Street 2:200
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1442
Practice Address - Country:US
Practice Address - Phone:775-686-6336
Practice Address - Fax:775-686-6327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1419208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV112373Medicare PIN