Provider Demographics
NPI:1881197192
Name:GEORGE W. RODWAY PROF LLC
Entity Type:Organization
Organization Name:GEORGE W. RODWAY PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:RODWAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, APRN
Authorized Official - Phone:775-200-9341
Mailing Address - Street 1:3507 WEDEKIND RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-1027
Mailing Address - Country:US
Mailing Address - Phone:775-200-9341
Mailing Address - Fax:775-470-7530
Practice Address - Street 1:2145 GREEN VISTA DR STE 112-B
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8543
Practice Address - Country:US
Practice Address - Phone:775-200-9341
Practice Address - Fax:775-470-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001489261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic