Provider Demographics
NPI:1730109935
Name:GRACCTIC, LLC
Entity Type:Organization
Organization Name:GRACCTIC, LLC
Other - Org Name:SUMMIT RIDGE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEFANKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-337-2012
Mailing Address - Street 1:4791 SUMMIT RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523
Mailing Address - Country:US
Mailing Address - Phone:775-624-2200
Mailing Address - Fax:775-624-2211
Practice Address - Street 1:4791 SUMMIT RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523
Practice Address - Country:US
Practice Address - Phone:775-624-2200
Practice Address - Fax:775-624-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care