Provider Demographics
NPI:1790746089
Name:PRIMARY CARE PLUS FOUNDATION
Entity Type:Organization
Organization Name:PRIMARY CARE PLUS FOUNDATION
Other - Org Name:SAINT MARY'S NELL J. REDFIELD HEATLH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-770-6229
Mailing Address - Street 1:235 W 6TH ST
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4548
Mailing Address - Country:US
Mailing Address - Phone:775-770-3930
Mailing Address - Fax:775-770-3939
Practice Address - Street 1:3915 NEIL RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6808
Practice Address - Country:US
Practice Address - Phone:775-770-3780
Practice Address - Fax:775-828-7788
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY CARE PLUS FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-28
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508167Medicaid
NV100508167Medicaid
=========OtherIRS - TAX ID