Provider Demographics
NPI:1760409783
Name:GOMEZ KOZAR MCELREATH AND SMITH PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GOMEZ KOZAR MCELREATH AND SMITH PROFESSIONAL CORPORATION
Other - Org Name:WESTERN SURGICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HULKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-323-7500
Mailing Address - Street 1:75 PRINGLE WAY
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1464
Mailing Address - Country:US
Mailing Address - Phone:775-323-7500
Mailing Address - Fax:775-789-9208
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:SUITE 1002
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-323-7500
Practice Address - Fax:775-789-9208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1002282691208600000X
NV2086S0102X, 2086S0120X, 2086S0127X, 2086S0129X, 2086X0206X, 208C00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504116Medicaid
NVWQBFQMedicare ID - Type UnspecifiedGROUP