Provider Demographics
NPI:1790055473
Name:UROLOGY NEVADA LTD DRS DREW FREEMAN GAREY-SAGE GOODE HALD KANELLOS
Entity Type:Organization
Organization Name:UROLOGY NEVADA LTD DRS DREW FREEMAN GAREY-SAGE GOODE HALD KANELLOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GABELICH
Authorized Official - Suffix:
Authorized Official - Credentials:FACMPE
Authorized Official - Phone:775-322-7811
Mailing Address - Street 1:5560 KIETZKE LN
Mailing Address - Street 2:BLDG. A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511
Mailing Address - Country:US
Mailing Address - Phone:775-322-7811
Mailing Address - Fax:775-322-1431
Practice Address - Street 1:5560 KIETZKE LN
Practice Address - Street 2:BLDG. A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511
Practice Address - Country:US
Practice Address - Phone:775-322-7811
Practice Address - Fax:775-322-1431
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UROLOGY NEVADA LTD DRS DREW FREEMAN GAREY-SAGE GOODE HALD KANELLOS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-11
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20071378617208800000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty