Provider Demographics
NPI:1790829471
Name:BENNETT SPANISH SPRINGS MEDICAL GROUP
Entity Type:Organization
Organization Name:BENNETT SPANISH SPRINGS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:STARR
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-355-3208
Mailing Address - Street 1:3380 N TRUCKEE LN
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-1570
Mailing Address - Country:US
Mailing Address - Phone:775-355-3208
Mailing Address - Fax:
Practice Address - Street 1:3380 N TRUCKEE LN
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-1570
Practice Address - Country:US
Practice Address - Phone:775-355-3208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV010-1001925939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty