Provider Demographics
NPI:1912027988
Name:WESTERN NEVADA FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:WESTERN NEVADA FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:775-284-3668
Mailing Address - Street 1:PO BOX 39000
Mailing Address - Street 2:DEPT 34159
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:775-284-3668
Mailing Address - Fax:775-284-4254
Practice Address - Street 1:15 MCCABE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-5991
Practice Address - Country:US
Practice Address - Phone:775-284-3668
Practice Address - Fax:775-284-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDE5177OtherRAILROAD MEDICARE PIN
NVV101133Medicare ID - Type Unspecified
NV5693970001Medicare NSC