Provider Demographics
NPI:1750502134
Name:CAPITOL ORTHOPEDICS AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:CAPITOL ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-888-9197
Mailing Address - Street 1:PO BOX 34120
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-4120
Mailing Address - Country:US
Mailing Address - Phone:775-747-5050
Mailing Address - Fax:775-747-5005
Practice Address - Street 1:755 N ROOP ST
Practice Address - Street 2:NUMBER 101
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-3106
Practice Address - Country:US
Practice Address - Phone:775-888-9197
Practice Address - Fax:775-747-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6610207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVMD6610Medicare ID - Type Unspecified