Provider Demographics
NPI:1902009897
Name:NEVADA DEPARTMENT OF CORRECTIONS
Entity Type:Organization
Organization Name:NEVADA DEPARTMENT OF CORRECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:BANNISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:775-887-3392
Mailing Address - Street 1:5500 SNYDER AVE
Mailing Address - Street 2:ATTENTION MEDICAL DIVISION
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-6752
Mailing Address - Country:US
Mailing Address - Phone:775-887-3223
Mailing Address - Fax:
Practice Address - Street 1:5500 SNYDER AVE
Practice Address - Street 2:ATTENTION MEDICAL DIVISION
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-6752
Practice Address - Country:US
Practice Address - Phone:775-887-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health